Guest Post

On doctors, BMI, and other bullshit (Guest post)

This week I had my annual visit with my doctor. I am doing great and really only need a renewal for my prescription of Ventolin for stress-induced asthma for when I run. I have never felt healthier in my life and have lost 35 lbs in the last two years thanks to a radical change in diet as well as workout intensity and regularity, including running (which I love).

I had a little smirk on my face when my doctor opened up by saying “You have lost weight”! What girl has not internalized this kind of discourse that requires of us that we be tiny and light and occupy as little space as we can?

So I was pretty happy with myself until the end of my exam where he asked how tall I was. I knew what was coming. I said: “Look, we are not going to get into BMI stuff because we both know it is bullshit!” He knows me and he knows I can be stubborn but also well-informed. So he asked: “How so?” My answer, of course: “Anyone who is muscular is going to bust the BMI and I am very muscular.” I thought this was going to be the end of it. No!

He pulled out a measuring tape and measured my waist and determined I have to lose 2 inches! On what basis I do not know. Now I am not going to claim there is no flab on my belly that I would not love to lose. But 2 inches? What he recommended? Doing abs! Ok, seriously! I went into how I strength train and run and do abs and can do 2 minutes of planking, no problemo! He said to try and asked: “You feel healthy?” Hell, yeah! Parting words.
I was really miffed by that whole thing because I am a very active person! I will not starve myself to lose 2 inches of waist measurement and I will not stop drinking, thank you very much. I probably do more exercise than most people, including my doctor, and I do feel the healthiest I have ever felt and the strongest! So what gives?

What I did when I got home? Ran to my closet to try all my pants to see if I had gained any unwanted weight and expanded in space. Because girls can’t, right? Of course everything still fits fine and no need for shopping (bummer). But I was still in the gym this morning busting my butt out with intervals and circuits because … that 2 inches gotta go.

With all of that being hyper conscious about all of these things and rejecting such fundamentally flawed discourses about women’s bodies, why can’t I just shake it off? The power of socio-cultural construction is indeed tremendous. And this is why we need to discuss such issues, be supportive of one another, and insist on being proud with feeling good.

19 thoughts on “On doctors, BMI, and other bullshit (Guest post)

  1. Hmmm… I apologize for asking so many questions. Just out of curiosity. Will assuming that your doctor think in terms of “prevention is better than cure” rather than in terms of aesthetic make you feel better and less defensive? Why did you meekly comply with your doctor’s advice and end up with pent up resentment? Is it not possible to seek a second opinion from a different doctor? What is the worst case scenario if you don’t lose that 2 inches? Diabetes? Bad for the knees? or other cardiovascular complications?

    1. I’m just going to note here that I think this comment misses the point. The declared things the doc is fixated on, given the rest of the profile she describes are very likely not relevant. It’s bad excersise advice for one, and his professionalism is in question for how he just took a measurement without asking permission or describing what the benefit versus the detriment would be. Assuming that someone with an MD always knows what is best for us, even in areas they may have no more or less expertise that the patient is dangerous. She wasn’t disputing a diagnosis of sepsis. She was positing that BMI is bullshit, which is true. She told him about her fitness level (which is good) and He told her she had a fat stomach. It’s wrong. Period.

      Finally, telling her that her meekness results in (unacceptable womanly) resentment is kind of crappy to say to a person who just blogged about a difficult personal moment. Probably feels similar to me noting this to you. You might consider that next time before engaging in this kind of public critique. Sorry, just being real here.

      1. Thank you so much for your well intentioned reply. Sorry that you take my inability to express myself well as not being real (the attributes of being a humanly) person. In the future, I will consider obtaining an MD, a PhD in Psychology and on top of that a PhD in English before making a comment even if I’m curious. It seems like some people make a living out of bashing others just because of some inconsiderate choice of words.

    1. Not so easy in Ontario. And I like one thing about him: he respects my desire to steer clear from medication as much as I can.

  2. I like how well you represent the internal struggle between what you know to be true and what you have been conditioned, as a woman, to believe (and feel good about and bad about at the same time). It’s too bad your doctor wasn’t more open to a different conversation. You are in such great physical condition and it just plain sucks to have Somme take out the tape measure and start messing with your head about it. For a few years, when I was trying to let go of old ideas about weight, I told my doctor I would not allow her to weigh me. She noted it in my chart and we followed that practice for at least ten years. I know it’s hard to find a new doctor in Ontario but yours sounds very old school and not the type who takes your intelligent comments and questions seriously.

  3. I once had a psychiatrist and a rheumatologist who kept nagging me to lose weight even though their records indicated I already was taking off the pounds steadily. And I remember my mother’s doctor telling her to lose only for her to poke him in his overweight stomach and say “you first”! Really liked your post and am glad it did not cause you to stop your exercise. I hope you can just keep at it.

  4. few doctors get nutrition training- and ab work to lose weight- ha he knows even less about exercise. Sounds like mansplaining to me. keep up your strength training and your running. You know you are doing great. I never look at the scale at the doctor’s office- it brings up bad memories of being obsessed with weight.

  5. If you doctor things that doing abdominal exercises will make your waist smaller, he is very much mistaken. Building muscle in the core (which is great, actually) can actually make the waist a bit larger. It seems he believes the myth of “spot-reduction”, which has no scientific basis: we can lost overall fat, but the distribution of the fat we have is mostly genetic. It always disturbs me when medical professionals fall into woo-science and bro-science myths, more so than people from other disciplines.

  6. You already know that your doctor doesn’t know what the f he is talking about. Measuring you after you declared you were not accepting that kind of “procedure” is actually a failure to obtain informed consent. That is unprofessional and unethical. So, seriously, new doc time if you can (not everyone has that option).

    Like Tracy, I also really appreciate how you describe that internal conflict of knowing/politics/principles and then triggered behaviors. It’s so hard to shake, that’s what it means to be embedded in a system.

    Keep planking! And running and lifting heavy things! You are strong and you can take up all the space you want.

  7. I agree with a lot of the comments that your doctor should have been more open to discussion with you about the best plan of action for your current and future health…..and that he has no idea about exercise if he suggested ab exercises for spot reducing your waist. However, as a MS in Exercise and Sport Science and a Certified Personal Trainer we are taught this about waist circumference and health specific to cardiovascular disease

    Waist Circumference

    Measuring waist circumference helps screen for possible health risks that come with overweight and obesity. If most of your fat is around your waist rather than at your hips, you’re at a higher risk for heart disease and type 2 diabetes. This risk goes up with a waist size that is greater than 35 inches for women or greater than 40 inches for men. To correctly measure your waist, stand and place a tape measure around your middle, just above your hipbones. Measure your waist just after you breathe out.
    The table Risks of Obesity-Associated Diseases by BMI and Waist Circumference provides you with an idea of whether your BMI combined with your waist circumference increases your risk for developing obesity-associated diseases or conditions.

    That came from the NIH website. While I agree that there is no one right body type, it’s important to understand the risk factors for disease and the ways many ways in which health can be measured. This is where the communication barrier between you and your physician seems to be….just my opinion.

  8. I have no idea what type of frame you have or what that measuring tape says for you. But I do no that having extra visceral fat is very very bad for your heart and that just compounds the older we get. I realize that it must be disheartening to hear after your two years of hard work that you still have further to go to be in optimal Health.
    Take his advise or leave it. But I would hope he is just trying to advise you based on health not on your physical appearance. I think we add all that other bullshit ourselves. It’s that internal judgemental dialogue that we have to look a certain way to be attractive.

  9. Thank you all for your comments on my post. A few things and context. The funny thing is that my measurement falls below the 35″ referred to above. There was no discussion of why I “need” to lose belly fat although I do know that too much belly fat is a health risk. He did not explain what the concern was. The recommendation on how to proceed is ridiculous at best. Indeed, building more core muscle will increase the waist line if one does not lose the fat. The fat just sits on bulkier core muscles. I was annoyed by a number of things but guess what: I went to the gym yesterday and busted my butt out with a circuit involved strength training and sprints. Today I ran 7K with 3 hills. And I feel great! I like doing it and I ain’t doing it for my doctor or for that 2 inches. And I am writing these lines after having had some vegan pizza and sipping on a beer. So there! 😉

  10. Oh, and did I dream this or there were studies showing that the female body naturally gets fattier with menopause as a means to protect itself against certain health hazards? If that rings a bell for anyone, I would love to get my hands on this.

  11. Oh, going to the doctor and being fat-shamed. SO MANY STORIES. I remember the first time I visited a clinic (I was having stress tests done) and a staffer said: you’re so tall and slim! Honestly, first time in my life. I could scarcely believe it (truly: I barely believed her). Until then, I took for granted that doctors exist to tell you you are fat and not healthy enough. (Cf dentist: floss more! Floss seven times a day! Oh, and buy some teeth whitening treatments…!)

    My advice: round out your care team with those who can offer better nutrition and fitness advice. I feel lucky to have a personal trainer, a family doctor, as well as a specialist who looks after a genetic condition I live with; between them I get a broad mix of feedback as well as advice. My trainer confirms for me that my strength program is obtaining good results that feed my competitive sports; my rheumatologist reminds me that my physical activity is supporting good joint and immune system health in the long term. When I get to the doctor and get weighed and measured and all that, I can then have a conversation, if required, over what I’m doing to stay healthy and strong in a global context.

    I’ve been a healthy weight for more than a decade, and I’m one of the strongest female cyclists in my city. My BMI has never dropped below 24, and is currently above 25.

    Fucking BMI!

    1. I have my care team and I also want to value how I feel. I have been rail thin before (believe it or not for those who know me) but I felt sickly on a daily basis and probably was at my unhealthiest.

    1. Oh yes! It is just a pain when these social discourses on bodies resurface and compete.

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