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Body Mass Index, Healthy Weight, and Mental Health in Utah

Body Mass Index, Healthy Weight, and Mental Health in Utah

Introduced in the 1980s, body mass index is today a ubiquitously cited statistic of healthy weight and obesity. On the news, online, in research, in public health information. It’s hard to be in this world and not at least hear about BMI. And like so many things to which we are constantly exposed, there’s a tendency to put too much importance on and trust in this measurement. This over-importance can have harmful effects when it comes to body image and mental health—whether it’s rising rates of eating disorders or simply making it more difficult to feel comfortable in our skin.

Utah is far from immune to these forces. In fact, there is evidence we may be suffering disproportionately. The state has the eight highest rate of plastic surgeons per capita in the country, something that Utah mental health professionals argue goes hand-in-hand with body image and issues of self-worth that are all too common. (For those interested in a long-form discussion of body image and middle-aged LDS women, we recommend this analysis.)


Who uses BMI?

Pretty much everybody, mental health professionals included. In fact, despite plenty of criticism and controversy from these mental health professionals, the latest edition of the DSM uses BMI to not only diagnose anorexia but also to describe the severity level:

Mild: BMI ≥17

Moderate: BMI 16–16.99

Severe: BMI 15–15.99

Extreme: BMI <15

Note that while these numbers may indicate the physical danger associated with anorexia, they say comparatively little about the shame and fear that likely led to the low body weight to begin with.


What’s Wrong with the Body Mass Index (BMI)?

Nothing’s wrong with BMI, but for many individuals, it’s a flawed indicator of healthy weight and overall health especially. And here’s why: It was designed and calibrated for large population studies in which the full range of body types are accounted for by the sample size. Thus, when we hear that the obesity rate doubled in the United States from 1980 to 2000, that’s a serious statistic and a troubling sign for the nation’s overall health. But it’s also a statistic that’s more properly cited in a discussion of the ways in which we subsidize high-fructose corn syrup—rather than an indictment of an individual’s waistline.

Indeed, body mass index is a crude, misleading tool when it comes to measuring healthy weight for any particular individual. Because it doesn’t distinguish between muscle and fat, people with more muscular builds are often skewed toward the heavy end. The numbers also tend to get skewed for people who are very short or very tall. Not everyone who is 5’1” and 135 lbs. is at unhealthy weight. Here’s another good example: In the movie, Superman, at 6’4” and 225lbs, is overweight. At 6’3”, 235 lbs., he’s borderline obese in the original comic.


So, what is a Healthy Weight?

One of the big reasons body mass index is so commonly used is because there is no better alternative. But this is simply because there is no easy standardization for individual bodies. Our individual physiology and body plan are such that it’s difficult, if not impossible, to create a single “metric” that is determinative of an individual’s health body weight. Here’s a better plan: Talk to your doctor. We know it sounds like a legal disclaimer, but in the right context, it’s also just good advice. Put another way: Don’t just to a doctor. Develop a relationship with a primary care physician that you like who knows your medical history, your family history, and your personal health priorities. This is the person to whom you ask, “What is a healthy weight for me, and why?”

On the other hand, if you’re struggling with the behavioral aspects of weight management, if you’re feeling overwhelming shame about your appearance, or if you’re terrified of the idea of gaining weight, a therapist might be a better choice of health professional.


More “Bad” Numbers: Weight, Physical Health, and Mental Health

Every hear the statistic that overweight people die, on average, 3 years earlier and obese people die 10 years earlier? It’s sad because it’s true, but it’s most likely true for more than just biological reasons. Obese people tend to make less money. They’re less likely to have friends. They’re more likely to be depressed, develop an eating disorder, or struggle with body image in general. They’re less likely to visit and follow up with their physicians—many of whom harbor a weight bias that can adversely impact their clinical judgement. (The Obesity Action Coalition is the leading advocacy organization for issues of weight bias.)

But here’s the real kicker. Once these stigmatizing factors are accounted for, the link between a healthy weight and longevity is substantially weakened. Moreover, as we cross middle-age, putting on a little extra weight is associated with a longer lifespan, and it’s been posited that this extra weight offers the body protective benefits. And this brings us back to the last reason not to put too much trust in the body mass index without talking to a doctor: It doesn’t account for changes in body type that occur as we get older.


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