Most women carry their weight differently from the much heralded 1950’s proportions of 36-24-36. Some of us are pear-shaped with big butts and spindly upper bodies; others have thin limbs and thick, pouchy middles. It’s possible to have a BMI within what your doctor calls the normal range, while having a ballooning stomach or buttocks. Not beautiful, but “normal,” we are told. Meanwhile, the modern American woman is concerned with the totality of how she looks. In a culture where thinness is practically a religion, being told by your doctor that your BMI is still “fine” is of little consolation.
For my daughter Sarah the BMI approach has been either totally irrelevant or a colossal failure, depending on your point of view. Ever since elementary school Sarah has struggled to control her weight. After being thin and petite for most of her childhood, Sarah began to gain weight on the drugs prescribed to control the emotional outbursts and inappropriate behaviors of her autistic spectrum disorder. At age 9, her special school insisted we try Risperdal, and while her behavior improved somewhat, she went from a ferocious fireball to a plump zombie. Finally, after 3 years of begging doctors to find a better drug with fewer side effects, Sarah was one of the first ASD kids to try Abilify at age 12. For a few years, she improved dramatically, with no weight gain until the summer of 10th grade when she suddenly gained 10 pounds in 8 weeks at summer camp. While I was profoundly grateful for her cognitive and behavioral improvements, I began to worry as she gained more weight and had trouble taking it off in spite of watching her diet and staying active.
Not a single one of Sarah’s doctors actually looked at her or noticed what any reasonable person would see: a small-boned young woman whose arms and legs were becoming sausages, and a belly that hung over her jeans. We are not talking about matronly, menopausal or post-pregnancy at ages 18 to 22. This was my Sarah, and what I saw was heartbreaking: an exquisite little girl—who had turned as many heads for her beauty as her erratic behavior—was going from plump to fat.
All the doctors could see was a person whose ASD symptoms had been well-controlled by a psychiatric drug known for weight gain and who still had an acceptable BMI. I’m sure they all think it’s a miracle Sarah was able to succeed in college long enough to experience “freshman” weight gain. Implicit in their reaction is that I should be grateful that my daughter with disabilities is functioning beyond their wildest dreams and not worry so much about her appearance. It’s not that I don’t have my priorities in order or that I’m some crazy perfectionist mother (okay, okay, I know some people could make that assumption), but why must my daughter forfeit her beauty—one of her biggest assets—to function appropriately? I’m quite certain that none of those doctors—even the psycho-pharmacologists—would accept their child’s ballooning weight without a fight. And let’s not forget that anyone (but especially a woman) with social challenges will be further isolated by being overweight.
What I didn’t realize until last month—when Sarah came home from college weighing an all-time high of 158 pounds—was that “normal” weight on the Body Mass Index table is a thirty pound range. For Sarah, that meant anywhere from 110 pounds to 140 pounds! Doesn’t this sound insane? I’m 5’9” and weigh 135 pounds, just below the mid-point of the normal range. If I somehow found myself at 162 pounds and a doctor told me that was still “within the normal range,” I’d want to shoot the doctor and myself.
Now enrolled in a weight loss program at NYU, Dr. Holly Lofton was at last willing to admit that Sarah was in the overweight range, with a BMI of 27. Dr. Lofton even asked Sarah what she would like to weigh and didn’t argue with her answer of 120 pounds. Finally, at the ripe old age of 22, Sarah (and her mother) were treated with dignity and respect. If only someone had listened to me sooner, my daughter wouldn’t have to lose 38 pounds on a meal replacement diet. It’s frightening (and infuriating) to think that if Sarah had gained only five pounds more, she would be diagnosed as obese—instead of (finally!) overweight—on the BMI chart. At least people listened before she became a bariatric candidate.
It’s no wonder that America has an obesity epidemic. Pretending that a person’s weight can fluctuate 30 pounds or more and still be “normal” is just a mathematical exercise in ignoring the problem. Instead of relying on an antiquated index to decide whether a person is a normal, healthy weight, why not use common sense? Not everyone can or should be a size 8 (or 6 or 4) but doctors should be able to look at individual patients and consider age, bone structure and muscularity to suggest a healthy 10 pound range.
I’m not just blaming the BMI (and the medical professionals who rely on it) for perpetrating the current weight myths. Surely the fashion industry is in cahoots with the doctors and mathematicians. At least here in America, women’s clothing is being cut larger while the corresponding sizes grow smaller. Any woman over 40 reading this blog knows that today’s size 8 is more like a 10 or 12. It’s no accident that “the perfect size 8” no longer exists; now it’s the size 2 popularized in “The Devil Wears Prada.” Even small, medium, large and extra-large sizes have been distorted to make overweight customers see themselves as normal. For most of my life, I’ve worn a medium. Now when I walk into the Gap, I have to buy a small or even an extra small tee shirt and my size 6 and 8 jeans are now 4s. No wonder they start the sizes at zero. If this crazy sizing continues, pretty soon we’ll be seeing sizes in negative numbers.
One day when you walk into a store and see a triple extra small or a size -4, you’ll know that body mass insanity has taken over completely.