Wednesday, May 1, 2013

Common Sense and the Body Mass Index Chart

Have I mentioned how much I hate the over use of the Body Mass Index, especially in children (but really pretty much for everybody)?  I do.  I really do.  I am constantly amazed at how it seems to take away all logical thought when it comes to the issue of weight from otherwise rational people.

Yesterday the girls had a doctor's appointment and I actually really like the office and the doctors .  There was one thing that had me resisting the urge to roll my eyes, however.  The doctor and I had to have a talk about Sadie's weight.  You see, her BMI, she said, puts her in danger of becoming overweight.

Now if she'd actually glanced at the child sitting in front of her she would have seen someone who looks like this:

I'm not sure what the definition of "overweight" is these days, but I'm pretty sure she doesn't fall anywhere in that category or "in danger" of that category.

It meant that we had to have a talk however, about how I need her to "exercise" more and stop giving her "sugary junk foods."

And that was simply too much for me.  I shook my head:  "These kids run around constantly.  They run around all day long."  "But the sugary junk foods?"  She asked.  "No."  My tone was adamant.  "Our diet is pretty 'crazy.'  The baby has allergies and as a result we went on an elimination diet and cut out pretty much everything that wasn't healthy.  Our diet is incredibly healthy." I later clarified that we eat mostly meats and fruit and vegetables.  And grains and things like that rarely, since wheat seems to make Mae break out in rash and scream for hours on end.

It wasn't like our diet was "unhealthy" before anyways.  It just involved more casseroles and grains and dairy.  And I occasionally used canned soups to help make sauces instead of making 100% of our food from scratch like I have for the past four months.

I'll admit that as a result of these type of conversations (which I have every time my kids are measured by a medical professional because apparently no one can actually look at the kids and see that they're muscular and thin) I find myself rolling my eyes every time the first ladies fitness campaign comes on.

Having lived on a very fixed budget I can say that I don't think the nations health crisis is rooted in this idea that people don't know the difference between healthy food and unhealthy food.  I think the vast majority of people do know that chips and soda are junk foods and apples and oranges are healthy.  However healthy food isn't cheap.  Our food budget was always tight.  Now it's "let's find 21 different uses for those dried beans in the pantry!" tight for the last week of my meal plan (I'm actually getting better at spacing the bean meals out throughout the month now that I've realized what a price difference there is when you cut out grains as the primary source of calories).  It's a struggle for me to figure out (although I do like the challenge and I'll admit it feels good when I finally make it work), and I'm pretty much a compulsive planner when it comes to our shopping list.

It would be cheaper and easier to shop off the dollar menu at McDonald's.  And a lot of people don't have access to a car to drive across town to get to a shopping area with somewhat reasonably priced produce.  So I always sort of wince when I hear tirade after tirade that seemed aimed at how people don't know what healthy is.  I think most people know that an apple is healthier than a candy bar.  But it's way cheaper to fill up your cart and your stomach with those less healthy calories.

On a different note, I do worry about those kids like Sadie, who hear their doctor say they're "overweight" or "in danger of being overweight" every time they go in to the doctor's office.  If we don't want a nation of anorexic teenagers, we might want to look up from the BMI chart and evaluate whether the child is actually overweight at all, or if they're all knees and elbows and ribs, before we actually say they're overweight out loud.

Every time I have this conversation I can't help but think that common sense doesn't seem all that common anymore!


  1. Next time tell the doctor to actually LOOK at Sadie. She's tall and beautiful. My husband is the same. He's 6 ft and 180lbs which apparently makes him nearly obese. Well he's a farmer and all muscle.

    I hated the growth charts when Ella was a baby. She was always too tall and under weight. Well what do they expect when her father is 6 foot and neither side of the family are big people??

    You are right, people know what's good for them and a lot of people just can't afford to eat that way. That's why bread and comfort foods are so prevalent in our diets. They were a cheap and easy way to get calories into hard working people. They are only bad now because of portion size and office work.

    I hope you can get the doctor to quit making those comments. I had to put my foot down with my MIL calling Ella her 'biggest grandchild' for the same reason (the other 2 look like they are never fed compared to my healthy girl). Girls especially don't need to hear that!

  2. My son was such a little guy he didn't even make the chart! I had to have him go through tons of tests and was eventually guilted to stop breast feeding for his own good. He was diagnosed as "failure to thrive." I felt awful, no matter what I did for him he stayed petite. Yet he was "healthy" eating and very smart just little. I wish I had just ignored all those charts and doctors comments! His parents are both shorter sized people and he was breast fed! With my daughter I'm going to worry less about all that:)

  3. Ummmm... theoretically, isn't almost everyone "in danger" of becoming overweight? I mean, except for people with severe crohn's disease or some other condition that completely prevents them from putting on weight, isn't everyone "in danger of becoming overweight"? I mean, it is like saying someone is "in danger of dying"? Aren't we all? How stupid.

    Yeah, all the doc offices are on alert over childhood obesity and I get the concern, as a child who was overweight, but they need to be sensible too. Sheesh.

  4. If the doctor did not submerse Sadie in water to determine her volume and buoyancy, he did not correctly determine her BMI.

    It's not be foolish people. Having healthy weights is important. Learning not to obsess about that fact is also important.

    I have a BMI of 21.4, but I am not a healthy 21.4. The weight is misdistributed and exists mostly in bone deposits rather than either fat or muscle. Every doctor I've seen has wanted me to put on weight since I was old enough to have memories forming.

    But hey, they must all be wrong, because I have a BMI of 21.4 so I must be fine, right?

    BMI is not nearly as important as the actual facts of your diet and exercise routine, and the actual statistics of heart rate and blood pressure.

    What modern BMI charts and calculators try to do is take an equation with three variables and determine all three of them from the product of those three variables, without any knowledge of the actual ratio between the three. BMI charts are predicated on an assumption of the least healthy possible ratio.

  5. THANK. YOU! I already have this problem with my kids and they are only 16m & 2m old. My son is tall & all lean muscle. He's looked like he was two since his first birthday. He's so tall I have to put him in bigger pants and then tighten the waist way down because he only has enough "fat" to be healthy. His sister is already following in his foot steps.

    One very rude nurse even said, "But you & your husband obviously aren't tall." with a very "this must be the milk mans baby tone. So I spent a whole visit trying to assure them that my husbands father is 6ft, but his mother is short so my husband ended up as average. My mom is 5'11" and is the shortest in her family. My uncle is 6'7". I just happened to take after the other size of my family. My little sister & brother already tower over me & are 10 & 12 years younger. I mean for goodness sake my husband & I aren't even short. We're just average.

    I truly respect doctors, but sometimes I think they are in school so long that they forget to use the common sense The Lord gave them.

    Then again these are the same doctors & nurses who saw my son walking all around the room at his 9m check up (he started walking at 8m). And then asked me if he could stand by pullin up on things. No lady, he skipped that & crawling and went straight to standing up on his own and then walking. Tell me again how unhealthy my children are.


    I've been overweight (and obese) in my life and, before I got pregnant this time, I was finally at a good weight for my height. But I have a large structure with wide hips and shoulders. For me, at 5'7, 160-165 actually looks nice. It makes me a size 8 in most clothes and, while I dream of that high school 150-155, my body seemed happy here. It was so nice to find a GP that looked at things other than just a BMI to say "yep, you're healthy!" and to have an OB who isn't obsessing about any of the weight I've gained with this pregnancy because of how I went into it.

    I look at Maya (who is slight, like her dad) and Bobby (who looks like a NFL linebacker and is S-O-L-I-D) and I can only wonder the pressure they will face. At three and a half, Bobby is already in size 4s and is 40lbs. He's a tall kid, like the neighborhood of 42". Maya? Not so much. She's still around 28lbs wet and a good head shorter than him. We just got her into 2T shorts, and some of her 18mo and 24mo fit too. I don't want anyone to look at them and judge them for any reason but it really makes me angry to think of using a chart instead of the child that is right in front of you.

  7. Sadie is not fat. Obviously. She might not fall directly on the 50th percentile for height and weight, but anyone can see that she's not a fat kid.

    Having said that, as a pediatric nurse, I do have to say that MOST parents do not recognize their own children's overweight or obesity. They write it off as "baby chub" or "he's just about to grow!" or "She's only five!" I would listen to doctor after doctor tell mothers that their (obviously) overweight toddlers and children needed to eat fewer calories and move more, and the parents immediately became defensive and indignant. His dad is a big guy! He's just short! It's baby fat! It's cute!

    Yeah. It was so frustrating because, well, you know - no one wants to hear that their kid is overweight or not as healthy as he should be. Of course parents become defensive. But so many times the kid actually IS too fat, and is well on the way toward a lifetime of battling his or her weight, and Mom won't make any changes and just calls the doctor "mean" or "crazy." These are the parents of 2-year-olds still drinking whole milk out of bottles, and the kids who can't take a trip to the store or the park without Mommy bringing snacks. They are literally used to having access to food at ALL times and parents think it's normal. I know, because our exam rooms were littered with their crackers, bananas and other detritus that should never be brought into a medical clinic (yuck!)

    So, while of course your child is not over-fat (which is the term I prefer, especially for kids, instead of "overweight"), I don't blame the doctors for being really vigilant about it. The bottom line is, probably 8 our of 10 moms do NOT take the advice to get their kids to slim down, they only get angry with the doctors and nurses for pointing out the problem and switch to an office where no one says a word about over-fat kids.


  8. We were threatened with the "failure to thrive" and weekly weight checks for our son for a lot of the first year. Our ped kept pressuring us to "feed him more" and "give him cheese with the cracker" when he was eating more than the 3-5 yrs at daycare. Our daycare provider actually sat us down one day after an appt where they stressed how underweight he was and said that they did not feel comfortable with making him eat more. He is an extremely happy and active child and once we had the voice of reason encouraging us to follow our instinct, it got a lot easier.

  9. My oldest daughter was always off the charts. Waaay off the charts in height and weight. Her BMI was always saying "obese" but our doctors could see that she was fine and no one ever marked it on a chart or said a negative word about her size. She's fine. She's lovely. At 13, she wears a size 12 women's shoe. Don't sweat it.

  10. I'd be so tempted to tell the doctor that he may only mention weight if he is also willing to pay for therapy in the future that results from such talk.

    My kids always get the "underweight" complaint. No matter that you could only get more down them if you either force fed them or if you fed them junk. In our house, we do no junk, which leaves force feeding and to me, that just guarantees weight issues later.

    Mine are healthy, athletic, and ahead of their age developmentally-- doctors often sound like an OCD persons who MUST find something to say that fulfills their compulsions.

    As for vaccinations, if civilization collapses, I'll be glad they got their shots and will only regret they couldn't have been given small pox vaccine too as I was as a child. Meanwhile, it should be more parental choice and less the role of the government than it is.

  11. I hadn't realized they were using BMI on children also. Don't they realize that a child's body is not like an adult's?

    That said, even though I am considered overweight, I've found that a much more reliable scale is the waist-to-height ratio. Of course, I'm a bit biased since it favors my hourglass shape :)

    More about the waist-height ratio can be found here:

  12. My daughter's BMI is high too, and it worries me a bit because she is bigger than my boys, but in every way - taller, heavier, so proportionately she looks great. Her 14 months older brother weighs 5 pounds less than her and is the same height, so people think they are twins. I think she might not get as much physical exercise as the boys because she does like to play dressup and dolls and color more than they do. I don't know, I guess we shouldn't worry unless a real issue comes up.

  13. Yes, they do use BMI on children. Wait until you get a letter home from the school nurse saying your child is "at risk" for being overweight.

    This whole BMI business really makes me sick. My 11 year old son has had a HUGE growth spurt in the past year, his shoe size is the same as his father's, and he is 2 1/4 inches shorter than me (and still growing). That being said, compared to other children his age, his BMI is "high." Plus, he plays basketball, baseball (catcher) and soccer (goalie). The BMI DOES NOT take into account the weight of MUSCLE.

    So what am I supposed to say when he reads the letter from the school nurse. "Am I fat?" he asks. "Will the other kids make fun of me?" No meeting with any medical professional--just a letter saying your child is overweight. Seriously???

    My 13 year old daughter has a higher BMI as well and she is just as active as my son. My kids know they come from short, stocky parents. It's our body type.

    In this day and age, and in this narcissistic society, I think the BMIs for children are sabotaging their mental well being. If the child is seriously overweight/obese, I can see the test being affective, but for the "at risk" kids, all they are hearing is "Oh yeah, just wait, your going to be fat, just wait and see!"

    Using BMIs when babies are young scares mothers, and using BMIs carelessly on school age children can result in bullying.


I love comments and I read every single comment that comes in (and I try to respond when the little ones aren't distracting me to the point that it's impossible!). Please show kindness to each other and our family in the comment box. After all, we're all real people on the other side of the screen!