Kira Lomas reports on the inaccurate and misleading nature of BMI in diagnosing eating disorders.
Photo by Jennifer Burk
Characterised by different behaviours related to weight control, such as undereating or overeating, vomiting, meal skipping and calorie counting, eating disorders are complex and debilitating conditions affecting around 1.25 million people in the UK.
The diagnosis stage comprises a combination of physical and psychological evaluations of the patient, alongside laboratory tests to determine if they require treatment. However, due to the current economic climate that has seen public services, especially the NHS, go severely underfunded, these thorough tests have been replaced with an inaccurate and misleading tool - BMI.
In simple terms, BMI (body mass index) is widely used to measure population health, dividing an individual's weight by their height. Although a straightforward tool, it has faced backlash from a number of groups including healthcare professionals, eating disorder victims and government advisors, all sharing the same message: BMI needs to be scrapped.
Barriers to Receiving Treatment
A report from the Women’s and Equality Committee states that using BMI as a measure for health systematically fails people with eating disorders. Further to the inquiry, several drawbacks were identified for BMI’s use within the healthcare sector in terms of inspiring weight stigma, contributing to eating disorders and disrupting people’s body image and health.
With the government’s focus on healthy eating to curb obesity, as well as the lack of diversity of body types in advertising, more and more people are becoming susceptible to developing an eating disorder. Not only are cases increasing, but patients are struggling to get the help they need based on their BMI being too high or too low. The system essentially implies that if you’re overweight or of a healthy weight, you cannot have an eating disorder worth treating. This type of weight-based stigma can have counterproductive effects, not to mention driving sufferers deeper into their illness and prolonging recovery rate.
“BMI should never be used as the sole factor in diagnosing eating disorders, or for determining who is ‘unwell enough’ to access to treatment.” - Beat, lead eating disorder charity
Despite improved research, public understanding of eating disorders remains limited, surrounded by a number of misconceptions. Victims of restrictive eating struggle to be taken seriously if they fail to look (what most people see as) ‘emaciated’. Whilst severe malnutrition is a common symptom of anorexia nervosa, it is not universal to all eating disorders.
Bulimia and binge eating are examples of restrictive eating disorders that do not necessarily result in an extremely thin appearance, yet they pose severe health risks and high mortality rates. The reality of these conditions points to an important fact: eating disorders can manifest in individuals of all weights.
New Strategy
With up to 2 million people estimated to be living with an eating disorder in the UK and hospital admissions on the rise, NHS services have struggled to cope with the demand, leaving sufferers to reach the lowest depths of their illness. Psychiatric experts have raised concerns to government officials about a ‘state of emergency’ for eating disorders, arguing that this issue needs to be tackled with early intervention and ongoing support for patients.
The lack of funding for healthcare services means that staff are not equipped with the right training to identify when someone should receive help for their eating disorder. Instead, doctors are relying on BMI as a quick determinator of a person’s right to treatment. The Women’s and Equality Committee are calling for government action against the use of BMI thresholds, and the implementation of a new national strategy that will be effective in providing patients with the support they need.
Using BMI to diagnose eating disorders has proven to be an ineffective and outdated approach. It is merely a number to define an individual that ignores other sociological markers of health, such as access to nutritious and affordable food, income and awareness of healthy eating. Understanding a person’s physical and emotional health in relation to their eating disorder, as opposed to judging them solely on their weight, is the next step to ensuring full recovery and a new, positive perspective on how sufferers view their bodies.
If you’ve been addressed by any of the issues discussed in this article, visit Beat, Mind or NHS support.
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