Tuesday, 19 January 2010

The B in BMI......

..does not stand for "be all and end all".

It’s an unfortunate side effect of being a woman and living in a culture which constantly demands superficial measures of “perfection”, that we always want what we cannot have. Ladies with lustrous, poker straight, shiny, swinging curtains of blonde hair long for a head full of raven coloured curls. Women with the slim, straight-up-and-down figure that means they can wear pretty much any style of clothing crave the curvaceous shapes of their more voluptuous counterparts, not knowing that their envy is entirely reciprocated.

As such, despite my friends insisting they were in fits of jealousy over my Amazonian frame, long legs and ridiculously proportioned bust, I always wanted the one thing my natural shape couldn’t offer me: A flat stomach. In addition to a tendency to carry excess weight around my middle, I also had invasive surgery for poloric stenosis as a baby, rendering my tummy a strange shape. So fixated became I on the elusive washboard abs, the lack thereof became all I could see when I looked in the mirror. A decade of what amounted to starvation because of excessive purging, abuse of laxatives and compulsive exercise meant my ribs and hip bones protruded aggressively and yet all I seemed to be able to focus on was a 3cm by 3cm pocket of flab, a consequence of my operation and also of all the bingeing I’d done over the years.

As I forced myself to vomit until I was dry-retching, I’d picture the concave middle I so desperately desired and then, red in the face, eyes streaming and sweating, I’d do hundreds of stomach crunches, but to no avail.

My university lectures were my only sanctuary from the insistent body insecurity that demanded my constant attention, because if there was one thing that was more important to me than being thin, it was learning. When I tried to read, I found it difficult to concentrate and the words would swim in front of my eyes because of the poor physical condition I was in, but listening to someone else expressing their passion for literature and the arts, imparting their knowledge, drawing me into their World and the World of the author or playwright and their characters (any World but mine, at that stage) was a real treat. One day, after class, a couple of my fellow students (not friends exactly but with whom I got on well enough) asked me to stay behind until everyone else had left the lecture hall.

After an age of meaningful looks being exchanged between them, one of them seemed to have been silently appointed The Spokesperson.

“We’re just checking to see if you’re ok”.

“Yes” (lie) “Why?”

“You’re so thin”.

(bizarrely pleased) “Really?”

“This isn’t a joke, Natasha. You look awful. Like you’re about to keel over. Please, please eat something”.

“ok. Thanks”.

I walked back to my halls of residence turning their words over and over in my head, vainly trying to find an excuse to continue my denial of having a problem, but I couldn’t. I booked myself in to see my GP.

During that doctor’s appointment, it was the first time I had ever admitted to anyone, aloud and directly, that I was suffering from bulimia nervosa and it was one of the hardest things I have ever had to do. My word came out in a whisper, disjointed as I stuttered that I had been making myself sick and that I’d been doing it for years. Without looking up from his notes, the GP asked me to get on the scales and after weighing me, concluded that I did not qualify for treatment because I was “not underweight” and sent me on my way.

Since working for Winning Minds, I have realised that I am not alone in this. Anorexics who weigh little over 6 or 7 stone have been told that until they reach the magic “anorexic weight” (which seems, for some reason, to be 5 stone) they are not considered to require urgent attention. Any sensible person who looked at them with their eyes could see that this was not the case – they require it, they desperately need it, their lives depend upon it. Similarly, several perfectly healthy and slim friends of mine have returned from a routine check-up in tears having been told that they are “obese”.

That is why I am very pleased that on 12th January 2010 the Daily Mail Online published an article entitled “He wears medium T-shirts, walks two miles a day and lifts weights in his tea break. So why is this man officially 'obese'?” To read the article click here.

I do not know what BMI is based upon, but I strongly suspect that it was entirely fabricated by one person (who was probably very short and had very small bones and virtually no muscle) a long time ago and has been taken as gospel by the medical profession ever since. The fact that entirely healthy people are being told they must lose weight as a consequence is bad enough, but it should definitely not be a contributory factor when assessing eating disorders, and in particular bulimia nervosa.

I am, of course, aware that doctors must have some means to determine the severity of an eating disorder. May I suggest the patient’s weight before their ED began as opposed to now, how quickly they have lost weight, how long they have been indulging in dangerous behaviours and to what extent it is affecting their lives? May I also suggest looking at them, with their eyes? Just a thought.

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