Why BMI is BS

  My thoughts on Anorexia versus Atypical Anorexia and the BMI requirement.

I am passionate about labels and diagnoses because my eating disorder thrived on not having a name. For years, I rationalized my disordered thoughts and behaviors because from the outside, my eating disorder looked like “discipline.” I was often praised for my “discipline,” for eating “clean” and exclusively drinking water. I was complimented for having a thin body. On top of that, I was told that what I was doing was normal (at least from what people could see)- that what I was doing if anything was simply eating “clean” and living a “healthy lifestyle.” I was an athlete after all. I had to take care of my body.

Very few people witnessed my obsessive behaviors with food and exercise. On top of that, no one knew how I truly felt about my body- how I was never satisfied with it. 

So from the outside, I appeared to be a highly motivated and disciplined female athlete. 

And THAT is how I was able to sustain my eating disorder for so long. I used the guise of being an athlete, specifically distance running, to camouflage my eating disorder. If there was any suspicion, I deflected by saying I did what I did to perform well.

Anorexia is, as defined by the Mayo Clinic, “an eating disorder characterized by an abnormally low body weight, an intense fear of gaining weight and a distorted perception of weight. People with anorexia place a high value on controlling their weight and shape, using extreme efforts that tend to significantly interfere with their lives.”

Atypical Anorexia is essentially the same thing- just without the requirement of having an abnormally low body weight.

It is interesting to me that Atypical Anorexia is called Atypical Anorexia because Atypical Anorexia is far more common than Anorexia. 

It is relatively rare for people with eating disorders to achieve an abnormally low body weight. This is because different kinds of eating disorders consist of different behaviors. And different bodies experience bingeing, restrictiction, purging, and exercise differently. While not everyone gains weight when bingeing, not everyone loses weight when restricting. 

The requirement for a below normal BMI is not helpful… for anyone. Eating disorders are mental disorders, not physical ones. Treatment should not be contingent on weight. 

*A little more on Weight and BMI in relation to health:

Weight in relation to health is a relatively new phenomenon. It dates back to the early 20th century when insurance companies began using patients’ heights and weights to determine what to charge policy holders. And it was not until 1985 that the National Institute of Health revised their definition of obesity to include BMI. People who one day were considered a healthy weight were all of the sudden labeled “obese” the next under the new definition of obesity. This change in definition launched the “obesity epidemic” as we know it today. Read Bizarre and Racist History of the BMI for more information.

BMI is, for the most part, baseless. The formula was devised by a mathematician with white men in mind. BMI was meant to be used as a statistical benchmark for populations, not as a measurement of the overall health of an individual.

But, the question remains, “What about the frail anorexic women who need feeding tubes that we see in shows, movies, and other media? Don’t they need more medical attention than someone with an eating disorder with a normal or above average body weight?”

No.

A person’s weight does not reveal much about their overall health. 

For example, I personally never achieved the right BMI to be classified as anorexic. My weight has always been considered normal for my height, even when I was restricting heavily, over-exercising, and abusing laxatives.

However, health wise, I was not okay. 

My magnesium levels were dangerously high. (I only found this out when I checked myself into a treatment program.)

I suffered a stress fracture among a myriad of other injuries due to my eating disorder behaviors. 

I lost so much hair. 

I experienced fainting spells and vertigo. 

My immune system was compromised- At one point, I was sick for nearly two months with flu-like symptoms and an ear infection.

My body was crying out for help. I very well could have needed to be hooked up to feeding tubes and an IV fluid drip.

But because I was an athlete, and because I never achieved the low BMI requirement for an anorexia diagnosis, there was no sense of urgency in treating my eating disorder.

I so badly wanted an anorexia diagnosis. When I was told by staff at my college health center that my eating disorder wasn’t serious enough to need blood work, I tried even harder to lose more weight. I thought that if I finally got down to that golden BMI, then I would at last be taken seriously. All my suffering wouldn’t have been for nothing. 

If only I weighed less. 

Maybe then I would matter more. 

It is dangerous for an Anorexia Diagnosis to be contingent on weight. This requirement actually makes it more difficult for people with eating disorders to seek or feel deserving of help. This requirement contributes to the already debilitating idea prominent in people with eating disorders that you’re never “sick enough” to deserve help. Eating Disorders in their nature are already difficult to talk about. They thrive on secrets, on silence. They become stronger in isolation. Being told that you do not fit the criteria for anorexia purely because of the weight requirement only validates eating disorder thoughts which then can lead to an increase in eating disorder behaviors. 

These eating disorder thoughts sound something like:

“Did you hear that? Average weight? They think you’re average.”

“Clearly you’re fine. No one is concerned about you. You’re normal.”

“You just want attention. You don’t even have an eating disorder. You just have to work harder than everyone else to maintain a normal weight.”

“Anorexia is the only eating disorder people care about or respect. They do not care what you are going through because you aren’t suffering enough.”

“If they think you’re fine, you obviously haven’t been working hard enough to lose weight. You can do better.”

Getting an Eating Disorder Not Otherwise Specified Diagnosis, while validating, crushed me. Prior to my intake appointment, I was convinced I checked the boxes for an anorexia diagnosis. It turns out I had ten pounds to lose for that. And as much as I tried, I was never able to lose those ten pounds. Those ten pounds would have given me the golden diagnosis: Anorexia Nervosa. Instead, I have had to settle for Eating Disorder Not Otherwise Specified, which is now Other Specified Feeding and Eating Disorder. And now that the diagnosis Atypical Anorexia exists, I would have probably been diagnosed with that. And I would have felt just as crushed. 

Atypical Anorexia implies;

“You’re not skinny enough.”

“Nice try. But you still have more weight to lose to have an actual eating disorder.”

“Atypical Anorexia? That’s just being bad at anorexia. Do better.”

Why must there be a weight requirement to meet the criteria for anorexia? Why must we continue to put so much emphasis on weight when treating an eating disorder? It certainly is not for health reasons. (I am fairly certain it is primarily for insurance billing and coverage.)

If you are hesitant to seek help because you feel you have not lost enough weight, this is your sign to seek help. You are still deserving of help even if you haven’t lost weight- heck, you deserve help even if you have gained weight! If thoughts about food, body image, exercise, etc are mentally and emotionally debilitating, there is help out there. There is hope. 

Do not let the anorexia criteria dissuade you from getting help. I know it is the most glamorously represented eating disorder out there. I know binge eating and bulimia are represented in the media  as the “gross” or “undesirable” eating disorders, but I can assure you anorexia is no less gross than any other diagnosis. It has just been glamorized because of diet culture.

We need to start seeing equal representation of eating disorders and people with eating disorders! We have the power, starting with revising once again the definition of obesity, and then changing the anorexia criteria, to stop people with eating disorders who exhibit restrictive behaviors from aiming for that anorexia diagnosis!

If you are aiming for that anorexia diagnosis, please stop.  

You can get help now. 

Don’t try to lose the five or ten or thirty pounds it might take to get there. 

You’ve got this.

Be gentle with yourself.

Stay safe out there.

With love,

Emily