Wednesday, October 23, 2013

Role Models and Weight: A Follow-Up Without all the Cussing

A few days ago, I wrote about being fat-shamed by an automated email after I participated in a health screening for an employee program designed to promote healthy living.

Admittedly, my initial response wasn't particularly mature (though I still think it was warranted). After a few days to reflect upon it, I wanted to explore it a little further because I am certain I'm not the only person being shamed by machines right now.

After receiving results within the recommended range on literally every other metric (glucose, both cholesterol measures, cholesterol ratio, cotinine, and blood pressure), I was told (as if I wasn't already aware) that my BMI was cause for an "ALERT."

Here is the advice that they gave me:
Successfully managing your weight plays a large role in managing your cholesterol, triglycerides, and risk for conditions such as metabolic syndrome, cardiovascular disease and diabetes. Always remember that you are an example for children and friends. You can help them stay at their ideal weight by guiding them to eat healthy low fat food and spend time together playing games that are physically active or taking walks together.
Nevermind that the very reasons they gave me for "managing" my weight (cholesterol, triglycerides, etc.) are already managed based on their very own results in the exact same report. The implication that I can't be a role model because of the ratio of my height to my weight is insane to me. And it enraged me.

In the past two weeks alone, here are the things my daughter has witnessed me doing. I've gotten up on several mornings and ran, including two times where I ran six miles in an hour. I've taken roller skating classes. I've gone to work, graded papers, and studied for my PhD exams. I've played games, cooked dinner, and danced with her.

She brought over a copy of Where the Sidewalk Ends and her toy computer to "study" with me the other night:

Not only am I capable of being a role model despite my apparently horrendous body, but I already am one. 

Then, to add insult to injury, I visited the site for the health program and saw that I had been awarded points for my in-range results. I got 600 points each for cholesterol, blood pressure, cotinine, and glucose. If I had gotten an in-range BMI, they informed me, I would have been awarded an additional 1000 points. 

I don't know why I cared so much, but I suddenly really, really cared. This program (which I otherwise really like, and which really has helped me set reasonable fitness goals and motivated me to reach them) was privileging BMI over all other health indicators. 

I wrote them a quick email in their form questionnaire asking them why they had made this decision. They responded that because "BMI levels over 25 are associated with many different health risks, we provide more points for a healthy BMI than we do for other biometric screenings." They admitted to a social stigma based on look-based rather than health-based goals, and assured me that they do not reward the 1000 points to people who are under the recommended BMI either. They also mentioned that they had BMI alternatives (getting body fat measurements from a doctor using calipers or analytical machines). 

That's all well and good, and I even believe that they have the goal of health in mind (everything else about the program is in line with that). But that's not how they present it. By giving BMI almost twice as many points as any other metric and by not mentioning the BMI alternatives on the main pages of the site, they create a false equivalency between size and health, an equivalency that is all too prevalent. 

I responded to their response with this:
Thank you for your response. I have had very positive interactions with your company, and I am hopeful that you will take this into consideration.  
For a little more context, I'd like to share some personal background. The only time in my entire life that I have fit BMI standards was when I was 17 years old. In order to meet them, I was eating about 500 calories a day: one Slim Fast shake and a few handfuls of Special K cereal. I also ran on a treadmill for two or three hours a day, obsessively counting calories in and out. I was starving myself. I was miserable, depressed, and hated my own body. Both my behavior and my eating were disordered. After almost a year of this kind of behavior, I clocked in just under the highest range of "normal" for my BMI. I assure you there was nothing healthy about it.  
I'm way past the time when someone else's idea of what my body should look like can make me act in that way, but I know that there are plenty of people for whom an insistence on BMI as a standard of health can trigger them to adopt some very unhealthy habits. BMI itself was not designed to be used on individuals (it was designed to measure aggregate populations), and much research shows it to be a flawed metric.  
It wasn't until I saw that you were privileging it over all other indicators (by giving it more points) that I felt compelled to write. I truly would like to see the research that impacted that decision. What proves that someone with a BMI over 25 is at a greater risk than a smoker if they don't also have high blood pressure or cholesterol, for instance? I truly don't understand why this indicator deserves almost double the point value of any other. 
I'm now the mother of a little girl, and I worry about the future and how she will learn to view her own body. Our culture's obsession with thinness to the detriment of all other health factors is mind boggling to me.  
Your program has helped me immensely. This is the second time I have used it (I had it through a previous employer), and in both instances, Vitality helped me set and keep longterm fitness goals. There have been several days when I would have talked myself out of a gym visit until I think of those goals and talk myself back into it. I was really excited to see it come to my new place of employment and immediately started telling co-workers about my previous experiences with it.  
I can't, though, recommend it to anyone else until I know that you are not feeding into a narrative that puts body size over healthy habits, and that's exactly what I feel like privileging BMI over other health indicators does. I am happy to hear that you have BMI alternatives (which I will look into for my own measurements), but they certainly aren't showcased on the site the way BMI is. Please consider the impact of not only your philosophy toward body size (which seems to be in the right place), but also the rhetoric surrounding how you present it to your members.
This whole conversation was sparked because a machine told me I couldn't be a role model, and that took me back to the one and only time I did make my body "worthy" of being an example. When I lost forty pounds in high school, I did indeed draw positive attention. People asked me about my workout routine. They wanted to copy my "diet." My diet was starvation, and my workout routine was obsessive. If there was ever a time that I was not a role model, that was it. No one sent me any emails warning me of that, though.

What do you think? Do you know of any research that would justify granting BMI double the points of any other health indicator? Would a message about your role model status be a motivator? Can size and health concerns co-exist reasonably? 


  1. I haven't looked for any research re: BMI over other health factors, but I doubt that there is any scientific rationale for giving double points for that- especially when all other measures are normal.

    The role model speech would motivate me only if I had not already taken steps to improve my health. The way it's worded seems to be under the presumption that some on over their BMI range has not yet started trying to get healthy.

    There is plenty of research about size and health and how someone can be overweight and yet still healthy and fit.

    Kudos to you for addressing them directly on this matter.

  2. Yes! I do think that there's something to be said for modeling healthy habits (especially for your own children). I want my daughter to see me use my body to the best of my abilities so that she will be encouraged to use hers. That's not just because of weight/fitness/health, though. Our bodies are how we interact with the world, and I want her to have models of positive, powerful interactions.