There is no question that I’ve lost a lot of weight through this illness. Which kind of goes without saying when you spent 5 months last year in an intimate relationship with the nearest available toilet. Unintended weight loss is a hallmark symptom of both Crohn’s Disease and other forms of Inflammatory Bowel Disease.
I’m not typical of most women in a lot of ways, and my relationship with my weight is no different. Unlike most of the girls I knew in my teens, I made a conscious choice not to go down the route of obsessing over what I put in my mouth or worrying about the numbers on scales. In fact, I don’t own a scale, other than my kitchen one (and I only own that because the British measure cooking by weight, not volume). I generally couldn’t tell you what I weigh, because frankly, who cares? I would rather worry about how I feel than numbers.
Unfortunately, the medical system doesn’t see things this way. I can’t walk into the IBD clinic without being promptly swept away by a nurse to be weighed. Again. And again. And again. And to have them obsess over every gram. It’s like they have a giant institutional eating disorder.
The thing is, when the weight was shedding off of me at an alarming rate in the autumn, no one seemed to care. None of the GPs I saw ever weighed me. Even the IBD clinic didn’t ask me what I weighed before this all started (not that I could really tell them). If it concerned them, they didn’t say so. To me, anyway. Of course, I was concerned, but no one else was.
Until the start of January. When the oedema cleared out of my legs virtually overnight, I lost 4.5kg in a week. That dropped me just below a Body Mass Index (BMI) of 18.5, which makes me officially underweight. Now, the clinic are having kittens.
On one hand, it’s nice that this is finally being taken seriously, but on the other, it's all they seem to be worried about. The fact that my kidney and liver function tests have come back almost normal now (and as an aside, my albumin levels are now completely normal, so no more hypoalbumineia), that I’m still not anaemic, that I’m feeling better and have more energy (and that everyone keeps telling me how much better I look) doesn’t compute. Nothing about me as an individual. All that matters is the number. That number has triggered an alarm on NICE guidance and they need to be seen to be doing something to comply with it. Again, it’s back to numbers - http://foodlovingcrohnie.blogspot.co.uk/2014/01/what-having-hysterectomy-taught-me.html
The problem for me is that I think the BMI is a deeply flawed measure of body mass and health. I went to a conference on eating disorders about 12 years ago for work, and went to a session on BMI. One of the speakers was a woman who was a varsity volleyball player at a local university. She was going to the Canada Games that year and was hoping to get on Canada’s Olympic Team. And after sharing this and talking a bit about what she was researching in her post-grad, she then announced that she is “obese”. She didn’t have an ounce of fat on her and judging by the size of her biceps, she could have probably taken down most of the men’s wrestling team at her university single handed. But according to the BMI, she is obese, because BMI is a simple calculation of mass in kg divided by height squared. No acknowledgement of body composition, age (in adults), ethnicity, body frame size, bone density, pregnancy, overall health or nutritional status, etc. This totally changed my view of BMI, and I have been a confirmed sceptic of it as a measure of health ever since.
There was an interesting article on the BBC about BMI this week - http://www.bbc.co.uk/news/magazine-21229387
There was also this (brilliantly titled) article about this theory published by Oxford University - http://www.ox.ac.uk/media/science_blog/130116.html
Under this person’s proposed BMI formula, I am just inside “normal” at what I weighed at the IBD clinic this morning. Not that I think his calculation is any better than the current system, especially when you factor in that this guy is a Professor of Numerical Analysis and doesn’t have a health background. But at least he is pointing out some of the inherent flaws in the measure.
There are lots of web articles out there slagging the BMI. Most of them are about obesity rather than being underweight, but they get at the point. My favourite is this video from lacigreen on YouTube - http://www.youtube.com/watch?v=GlXxoG98urc
As an aside, I really like lacigreen's videos. You should check them out.
The thing is, the clinic's institutional obsession with this measure is making me obsess about getting my weight up just to satisfy them. And I don’t want to turn into one of those women who obsesses about weight. The numbers are only part of the picture, not the end all and be all.
And for the clinic’s reference, I have not bottomed out at the lowest weight I have ever been at in my adult life. I have a way to go before that. Ironically, that also happened when I was on a high level of steroids. But the IBD clinic never asked about that. . . .
I’m not typical of most women in a lot of ways, and my relationship with my weight is no different. Unlike most of the girls I knew in my teens, I made a conscious choice not to go down the route of obsessing over what I put in my mouth or worrying about the numbers on scales. In fact, I don’t own a scale, other than my kitchen one (and I only own that because the British measure cooking by weight, not volume). I generally couldn’t tell you what I weigh, because frankly, who cares? I would rather worry about how I feel than numbers.
Unfortunately, the medical system doesn’t see things this way. I can’t walk into the IBD clinic without being promptly swept away by a nurse to be weighed. Again. And again. And again. And to have them obsess over every gram. It’s like they have a giant institutional eating disorder.
The thing is, when the weight was shedding off of me at an alarming rate in the autumn, no one seemed to care. None of the GPs I saw ever weighed me. Even the IBD clinic didn’t ask me what I weighed before this all started (not that I could really tell them). If it concerned them, they didn’t say so. To me, anyway. Of course, I was concerned, but no one else was.
Until the start of January. When the oedema cleared out of my legs virtually overnight, I lost 4.5kg in a week. That dropped me just below a Body Mass Index (BMI) of 18.5, which makes me officially underweight. Now, the clinic are having kittens.
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| Did you think this blog would be free of pictures of kittens? |
The problem for me is that I think the BMI is a deeply flawed measure of body mass and health. I went to a conference on eating disorders about 12 years ago for work, and went to a session on BMI. One of the speakers was a woman who was a varsity volleyball player at a local university. She was going to the Canada Games that year and was hoping to get on Canada’s Olympic Team. And after sharing this and talking a bit about what she was researching in her post-grad, she then announced that she is “obese”. She didn’t have an ounce of fat on her and judging by the size of her biceps, she could have probably taken down most of the men’s wrestling team at her university single handed. But according to the BMI, she is obese, because BMI is a simple calculation of mass in kg divided by height squared. No acknowledgement of body composition, age (in adults), ethnicity, body frame size, bone density, pregnancy, overall health or nutritional status, etc. This totally changed my view of BMI, and I have been a confirmed sceptic of it as a measure of health ever since.
There was an interesting article on the BBC about BMI this week - http://www.bbc.co.uk/news/magazine-21229387
There was also this (brilliantly titled) article about this theory published by Oxford University - http://www.ox.ac.uk/media/science_blog/130116.html
Under this person’s proposed BMI formula, I am just inside “normal” at what I weighed at the IBD clinic this morning. Not that I think his calculation is any better than the current system, especially when you factor in that this guy is a Professor of Numerical Analysis and doesn’t have a health background. But at least he is pointing out some of the inherent flaws in the measure.
There are lots of web articles out there slagging the BMI. Most of them are about obesity rather than being underweight, but they get at the point. My favourite is this video from lacigreen on YouTube - http://www.youtube.com/watch?v=GlXxoG98urc
As an aside, I really like lacigreen's videos. You should check them out.
The thing is, the clinic's institutional obsession with this measure is making me obsess about getting my weight up just to satisfy them. And I don’t want to turn into one of those women who obsesses about weight. The numbers are only part of the picture, not the end all and be all.
And for the clinic’s reference, I have not bottomed out at the lowest weight I have ever been at in my adult life. I have a way to go before that. Ironically, that also happened when I was on a high level of steroids. But the IBD clinic never asked about that. . . .
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