On Obesity, the Body Mass Index, and Really Bad Advice

I have a friend that I have known over a decade who told me recently that her doctor told her that she was clinically obese, and that he wanted to put her on weight loss medications. She was furious, claiming that he did not understand that her muscle weighs more than fat, and that she is actually in really good shape. She asked how she could be in such good shape, and still be obese.

I am obese. I am what is classified by Health Canada as Obese class II, which means that my Body Mass Index (BMI) is between 35.0 and 39.9. A few weeks ago, I wrote a piece called STOP THE PRESSES! I AM OBESE! I wrote this the day that I realized that I dropped out of the classification of Severely Obese (which had previously been called Morbidly Obese). I am looking forward to achieving my next huge milestone, which will be to fall into the Obesity Class I category, which will mean that my BMI is below 34.9. For perspective, today my BMI is 36.1, and on February 1 it was 37. I have lost 6.6 lbs. in that time frame. As I lose the weight, my BMI drops, and I can see my progress, as well as the health benefits from into the lower classification.

In other words, it is a great tool for those who are overweight and need to lose weight.

My friend is not overweight. She is extremely muscular, and from her Facebook pictures (of which there are many) she does not look overweight to me. She does not feel overweight. Yet her doctor, who is not a weight loss specialist, looks at her and says that she needs to lose weight.

The BMI is flawed in that it takes into account two factors only: height and weight. If you are this height, and you weigh this much, then this is your BMI, and you are either obese or not. We have known for decades that muscle weighs more than fat. How then can we say that a man who is 6’2” tall and 225 lbs. of solid muscle is obese? If his twin brother was the same height and weight, but was out of shape with a paunch, then that classification would make sense. To call someone obese based on a chart that accounts height versus weight just does not work.

When I was going to weight management clinics in the past, the specialists taught us that the BMI is a flawed system. It works for those who are truly fat, but it cannot be applied equally to those who are in good shape. Why then would a doctor look at a patient, having obviously examined them thoroughly, and tell them, ‘According to this chart you need to lose weight.’? It is going to accomplish nothing other than to give the patient a complex. When people are told by their friends that they are overweight it hurts their feelings. When a doctor says it, that means that it must be true, and it can adversely affect their psyche. I do not know what psychological effects this misdiagnosis will have on my friend, but I know that it was weighing on her mind enough that she was complaining about it to me on a Saturday night.

Doctors know that their words are, for many patients, gospel. If they say the patient is fat then it does not matter what size jeans they wear, that’s it. As such, they should know that there are other factors to a healthy weight than just the numbers on a chart, and if they do not then they should not offer uneducated opinions or advice that will hurt their patients’ feelings for no reason.

I am glad that my friend refused the weight loss medications that the doctor wanted to prescribe because nobody wants to lose muscle. If she wants to keep her muscular body then she should not be encouraged that ‘this or that very flawed chart says that you need to lose weight, so lose weight.’

The Body Mass Index is very helpful to me on my weight loss journey, and my family physician who has been monitoring me for the past year has been extremely helpful and encouraging on my journey. He also recognizes that as a general practitioner, he is not a weight loss expert, so when he is not sure about something he would rather give me no advice than bad advice. Perhaps my friend’s doctor should take a lesson from him.

In our culture, our body image is a huge factor in our self-worth, and while that is probably unhealthy, it is absolutely true. Body shaming is disgusting from our friends and loved ones, and from strangers on the street who feel it is their place to comment on someone’s size. From a medical practitioner it is absolutely unconscionable, and when the doctor is ignorant on the subject it should be left to the professionals… or at least to doctors who are smart enough to know that two factors alone cannot determine a healthy body size.

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