Weight Talk: Fitness, Health and Society

The problems with BMI as it exists aren't horrible. There's flaws in how it was originally built, and unusual bodies can make it useless. But as long as the people using it to screen patients are aware of that, it's a usable first step.

The bad problem with it is twofold. First is the practitioners that don't use it properly as a screening tool rather than an indicator of disease/disorder. Second is random assholes out in the world with no training trying to act like they know enough to use it for anything at all.

The second one is whatever, because people gonna people.

The first one though? It's disturbing. When you're sitting there with a high BMI, and you could pick the md/np/pa up one handed, and they start talking about obesity, that's a very, very bad sign for the provider. And it happens. It happens way more than is reasonable because the people that are providing care are either being taught wrong, or aren't paying attention during college.

BMI as a first step screening tool is very valuable. It gives a simple, easy to use metric to assess risks. But it has to be the first step out of many, even for patients that do have a body that's legitimately overweight or obese. When BMI turns into the sole determinant of how a care provider addresses the patient, the whole thing breaks down. When BMI isn't useful for a patient, and the provider still tries to apply care that isn't appropriate because of the BMI, the system itself is flawed more than BMI itself.

Being real, most people aren't going to be so tall or built that BMI is useless. Most aren't even going to hit the sizes where it starts to be less useful. It is a niche issue. And, in all reality, if you're that tall/big and your doctor is ignoring that he or she could stand on your back and you could still crank out pushups like nothing, the BMI isn't the biggest concern. What else are they ignoring that could cause serious issues rather than just pushing harmless but ineffective dietary advice?

Which, you don't even have to be a serious lifter for that kind of issue. There are obese patients that receive bad care because they're obese, and that's where a doctor starts, but refuses to abandon it or otherwise address an issue that's causing a problem. Like, my buddy going in with digestive symptoms, being told to lose weight, and a year later it turns out it was an autoimmune issue.

Yeah, obesity can cause weird stuff with digestion. But having to wait a year for appropriate testing after switching doctors, that's still bullshit. It's a thing, it happens, and it happens a lot more than it should among disabled patients.

Mind you, it isn't only thing doctors get hung up on like that. You come in disabled, and chances are that a provider is going to keep assuming the original disability is the cause of the new symptoms. Which is fine enough until they give up rather than pivoting to alternate possibilities. But that's only relevant in that it illuminates the underlying problem: that not all doctors/nurse practitioners/physician assistants are graduated with the same skill and knowledge. The patient still has to be their own advocate because providers are still human and humans screw up sometimes, even when they're the best in their field