Thursday, December 14, 2006

The BMI, female athletes, the triad, eating disorders and me

I hate the Body Mass Index. Why? Because according to the Body Mass Index (BMI), I am overweight. According to the Body Mass Index, I will likely always be overweight except when I starve myself, at which point I might end up in “healthy”.

The BMI was invented between 1830 and 1850 as a way to determine statistical averages of weight. It does not calculate body types, or fat percentages, or even gender, simply height and weight – and the new “adjusted” BMI’s say that the taller a woman is, the less she should weigh (per inch). But the problem is that the BMI is being used more and more as a diagnostic standard. But even there doctor’s disagree, with some saying 18.5 BMI is a healthy weight, while others say women shouldn’t fall below 20. Meanwhile, the NHS in the UK has set a standard of 13.5 on the BMI scale in order to be treated for anorexia. To put that in perspective, I weight 210 lbs after nine months of exercising a minimum of 8 hours a week and restricting my food intake. To qualify for treatment for anorexia in the UK, I would need to be, according to my height, about 108 lbs. I find that funny because I used to keep this picture of me from high school; all you can see are sticks connecting giant elbow and knee joints, and every rib protruding – I was 170 lbs. Later in college, after eating less than 500 calories a day for 9 months, I was somewhere between 159-162 pounds; I couldn’t generate enough body heat to keep warm, I bruised if I sat or lay down, I would pass out or fall over when I was running (exercise, exercise!) and people said that it “nauseated” them to look at me. I had a hard time with jeans because you could see my entire pelvic bones, the whole bowl shape with skin stretched across them. To see my bones, where you could see my ribs bones breathing in and out even through my clothes, used to give me such satisfaction. But I was never anorexic, right, right, because the BMI tells me, and the doctors, so.

It seems odd because, anorexia seems out of fashion these days. All I seem to read about it bulimia, unless you are a fashion model, that is, like Ana Reston who died of anorexia earlier this year (at death her BMI was 13.5, which would allow her corpse to get treatment in the UK – just too late for her). Since then, Brazil and other countries have started imposing restrictions on models, based again on the BMI indicators. The problem is that the BMI, like any indicator, has serious flaws – particularly when talking about individual people instead of statistics. If you look at Ana Reston’s picture, taken during a long period of anorexia, she doesn’t look anorexic, does she? The other problem is that if you are an athlete, even a fairly serious amateur athlete, you will never score low enough on the BMI to reveal serious eating difficulties (and if you are a serious female athlete, you probably HAVE an eating difficulty).

For example, Shaquille O’Neal has a BMI of 32, which rates him as “obese” to “morbidly obese” and so seriously overweight he is in life threatening danger due to his inactive lifestyle...according to the BMI. But the BMI can't tell how much of your weight is fat or how much is muscle. For instance, amenorrhea, which is when the body fat in women reduces low enough to stop menstrual cycles, is undetectable through BMI and studies have shown that female athletes with amenorrhea and without amenorrhea based on unhealthy versus healthy amounts of body fat score exactly the same on the BMI. And with the weight of muscle over fat, eating disorders are harder to spot among female athletes. That is not to say they don’t exist; eating disorders among serious female athletes are 10 times more prevalent than the average population – though again, because diagnostic indicators are almost irrelevant when used against elite althetes, a Canadian study shows how varied the studies when it states:“The prevalence of eating disorders amongst female athletes is reported to be between 15% and 62%” While two US studies says that at least a third of female athletes have disordered eating. What is constant is that at least ½ of female athletes feel constant pressure regarding weight, and over half are on some form of food regulation. A majority of female athletes want a body fat percentage that is dangerously low (13% compared to the healthy norm of 17-27%), 81% feel “out of control” if they overeat and on every single item on the Rosenberg Self-Esteem Scales female athletes had lower scores than male athletes. Some of this pressure comes from the person: “perfectionism, compulsiveness and high achievement expectations are personality traits thought to be advantageous for the competitive athlete; however these very traits are commonly associated with the development of an eating disorder.” While other times it comes from coaches, the team and the environment, particularly in sports where lean is linked to winning performances.

But what about fencing? Fencing is the “odd” sport, as it doesn’t require a body type; According to Mark Masters, a coach in Philadelphia, "A lot of women who come to fencing haven't participated in conventional sports. In school, they were poor athletes--they couldn't throw a ball, weren't fast runners, couldn't jump high. With fencing, they now have a niche." What they don't tell you about fencing is that, unlike other sports, you will get fit, but not lean. In a study of male teens, fencing created the second highest BMI rating next to weight lifting (a higher BMI than basketball and even swimming). The development of powerful muscles in fencers gives them a BMI rating comparable to the “control” group – the group that sat on the couch playing games and eating cheetos. A look at the 16 top elite fencers at the last Olympics as well as some of the elite Canadian female fencers gives an average BMI of around 24; according to the BMI, just this side of “overweight”.

And how does that affect me? In the six weeks going up to the Nationals, I really poured on the training....and gained 8 pounds. That drove me crazy, particularly as I had restricted my eating significantly. Another female fencer in her thirties said that is just that way it is, welcome to “fencer thighs” and that she, at least 8 or 9 inches shorter than me, was 175 lbs. I should clarify, when I said, “drove me crazy” I mean it started a trigger. The more stress I am under, the less I eat, the more I crave control, the more I exercise. Right now, at most, I eat once a day. My calorie intake for the last month is 1/3 of what it was a couple months ago. It would be even less except years on diet drinks has made me severely allergic to aspartame – so no more meals of diet coke and celery. This is a problem.

I have always said, in private, that anorexia is an addiction, at least for someone like me. It is how I cope in times of trouble and though I have been almost 3 years with “healthy eating” all it takes is enough stress, or enough negative feedback or enough whatever is needed to start the trigger. And I will tip into that need to hold some part of myself in control so that no matter what is done or said to me; I have a part that no one can touch: they can’t make me eat. Of course, I win this “victory” at the cost of my own body. I said it in private because talking about eating disorders is very taboo if you are supposed to be an intelligent professional – you are supposed to have it “together.” So saying that starving is responding to emotional demands which are far greater than the puny emotional influence an idea like “you are threatening your survival” can bring to bear is a bad thing. But actually thanks to Faith over at the blog That is So Queer, I saw that you can post about being both an intelligent human being and a flawed human being.

That being said, it is possible to be both an intelligent human being and have ideas or actions which are not.....let’s call it optimal (I've lost 9 pounds this week, woo hoo!). Starving yourself doesn’t make you perform better, nor does it make you feel happy. It might make you an unhappy person who feels in control. But it also threatens your very future, particularly if you enter what is called the female athlete triad: This triad is characterized by disordered eating, menstrual dysfunction and osteoporosis – and ironically turns an activity which should benefit women into one which shortens their lifespan ("I have seen girls who had been in their 20s who had been amenorrheic for several years who had the bones of a 70- or 80-year-old woman," says Seattle-based research physiologist Barbara Drinkwater). How high the percentage of women in the triad changes from sport to sport but studies indicate that a majority of female athletes are under increasing pressure regarding body image, weight and ideals and a majority develop patterns to deal with it (according to a study by RL Rosen, 75 percent of female college gymnasts who were told by their coaches that they were overweight used pathogenic behaviors to control their weight.)

As Mr. Ho says, I’m a big female, very big. And I don’t think the BMI will ever tell me that I am in the middle of the “healthy” range – no matter how many hours I exercise. I used to have this deal with my body; eat what you want as long as you exercise – it was the pact I made so I would not weigh myself. Yet now, in the best physical condition for a decade, I currently feel guilty for every day I don’t exercise at least an hour and every meal or snack I eat? I’m so healthy that I’m sick. Isn’t it ironic? (Of course, remember, the BMI still labels me as “overweight” so it’s all justified, right? Right?)


Wendryn said...

I inherited my dad's body. Whne I was in very good shape in high school, riding many miles a day, swimming men's varsity, and backpacking on the weekends, I was 5'2" and 160 pounds. That put me at the top of the overweight category, verging on obesity, but I was in *really* good shape. I have wide shoulders, wide hips, and heavy bones. I had a bone density test at one point and the doctor just laughed at the results - "You certainly don't have to worry about osteoporosis, do you?"

I hate the BMI chart, too.

I have had doctors tell me I should be at most about 130 pounds. I cannot get there short of getting very, very sick. My body just flat-out won't do it. ASt 160 I was lean. My stomach was flat and tight. I was very muscular. I still had breasts, but they were only a C cup. Lose 30 pounds from that? I have no idea where they would come from.

I don't have a scale in the house anymore. I swim several miles a week, walk a lot, and will be riding just about everywhere again once I get a bike. I am comfortable with being perceived as overweight, even obese, because I know I can out-exercise just about everyone I know, even those in the "healthy" range.

I have accepted that I am short, wide, and strong. Whenever I start fencing, I will use that to my advantage. My doctor knows better than to bug me about weight. We have a deal. She can put me on a scale as long as she doesn't pester me about it. My blood pressure and cholesterol are consistently fine, and treadmill tests say I'm in decent shape.

My sister went anorexic. She had a choice - she is more lightly built, so she could get closer to normal than I can. I know, at this point, that I just can't get there, so I don't stress it (well, most of the time, anyway).

OK, rant over. The BMI is stupid. Eat *AND* exercise and you will stya healthy.

Daniel, the Guy in the Desert said...

My body doesn't fit on any indicators, as I have positively freakish muscle mass. 240 lbs is the top of my (actually) healthy weight range, and 215 the low end. I'm 5'10". Go figure. I never took unnatural supplements to get that way, btw.

David said...

Yup, BMI is not a very useful measurement for lots of people, particularly anyone actively doing sports.
I'm 188cm / 88kg - so according to BMI I'm just on the border of normal/overweight.
I'm an epeeist ... I look like an epeeist - tall and lanky. I'm more likely to be called skinny than overweight, even now that I have an actual "spare tyre" starting to form.

Sober @ Sundown said...

My BMI is 19. It could even be 18 since they don't require you to take off your shoes, or jeans or remove mp3 players, or phones from your pockets at the doctors office. I am actually quite stressed about being 19, and thought I should work to become at least a 20.

I try to gain weight like you try to lose it. I get really stressed if I don't eat three meals a day. I started working out just to gain muscle. It is much easier for me to build muscle than to increase my fat cells. I do 86 push-ups and use 20 lb weights to cover the bones in my chest cause I don't have any fat there.

Anonymous said...

Thanks Elizabeth. I was so freaked out about this at first. I mean, I'm supposed to be a medical professional. How is anyone who reads this going to take me seriously if I admit to bulimia. Fact is, people have responded much more positively than I thought. Also, now that my dirty little secret is out, I am not nearly as eating disordered.

Don't read the charts.

Eat to fuel your passion.

Happy new year!

Anonymous said...

well i am under weight for my age but i think i am fat but, one day one of my friends found out that i was anorxic so she kept telling me not to be anorxic and noe i know that being anorxic could kill you my BMI was 17.3 but now it is a healthy 18.2.

Taylor said...

Great post, It is scary how prevelent eatind disorders are. My 2nd and 3rd year of college I consumed less than 500 calories per day and worked out 2-3 times a day. I think that conventional systems such as BMI is outdated and needs to be adjusted. Clearly we are all built different and that needs to be taken into consideration. I do not think that someone should have to weight 100 lbs in order for a red flag to go up!

isabella mori said...

very interesting post. BMI seems seriously, seriously flawed as an index - and no wonder, seeing how it's calculated. yhour juxtaposition of different people with different BMI's is fascinating.

Anonymous said...

Reading your blog made me feel alot better. I'm a female college swimmer who had anorexia from about age 10-17. I'm still dealing with the reprocussions of the damage done to my body, but now I'm on the high end of healthy/cusp of overweight on the bmi chart. I'm pretty in shape and healthy and I'm trying to eat right. I wish they didn't try to put everyone into a certain set of standards. Everyone's body is different. But yes, even at my lowest weight during my anorexic hayday I would have still been considered "healthy" barely on the bmi scale. Funny because I was eating so little and still swimming 2 hours a day that my metabolism wasn't burning more than 900 calories a day. But still healthy according to BMI.

Aurora McKean said...

I'm 5ft 11 and 160lbs and according to 'accounts of other people my height and weight I should be a uk size 12-14 (usa 8-10) at the smallest and have flab. Screw that, I am a competitive dancer and figure skater and regularly surf, sail and horse ride. I have a flat stomach, firm thighs, breasts but only a 32C. My collarbones and ribs show. A few years ago I went on a crash diet and went down to 140 basically starving myself and everyone said I looked ILL. But according to doctors I would have to be 115 to be diagnosed as anorexic.

penniesinourpockets said...

Bmi is utter bull in my opinion. I'm by no means an elite athlete but I like a good bit of sport. At a bmi of 20 I'm apparantly healthly, amenorrhea and random fainting aside, I weigh the right weight so in the doc's eyes there isn't anything wrong with me. If they were to just use their eyes (I aparantly look about 7 1/2 stone, with in fact being 2 stone more than that).
but that would use something most medics I know don't have, initiative.

Anonymous said...

Interesting comments.

BMI chart is certainly misleading; as some people mentioned, it does not consider bones, muscle, shape....
however, I have not seen any other "objective" easy to calculate chart. I just see it as a possible indicator.

younger, I used to be very worried about my size. In college, I was 5'11 / 125 pds with BMI of 17.3 ; There are lots of sports and activities I did not get involved in because I was - or thought - I was too skinny. And I certainly would rather have died than date a woman heavier or stronger than I was !

Although I was upset, I have never suffered anorexia, and have always eated as much as I wanted. But I probably always had good eating habits, without even thinking about it. And although I never got into organized sports or any fitness program, I've always been very active, walking, swimming and cycling a lot.

We probably should spend less time guessing what other people might think we look like, and just live our lives. And we should also be careful ourselves to avoid despising or judging bodybuilders, athletes, obese or skinny people.

Pierre T.