I’m fat. It’s fact. I’ve been fat for most of my life.  There really is not a time that I don’t remember being fat.  I was always heavier than girls in my classes in school. No matter how active I was I was always bigger.  As I got older my eating habits changed and not for the better; sadly the freshman 15 was more like the freshman 30!  As I studied and had the college experience my activity level diminished.  

Unfortunately this pattern continued even in medical school.  Sure there were times when I started having a healthier lifestyle but “life would get in the way”.  It wasn’t until I finished residency and was an attending that I realized I needed to put my health front and center.  I changed my eating habits, exercised regularly, and focused on myself. However my weight never reached the Body Mass Index (BMI) goal for my height — 130lbs.  At first I was discouraged and tempted to just give up. However, I ultimately decided to learn more about the BMI.  

The BMI, a tool that is used heavily in healthcare as an indication of “healthy” weight, was developed in the 1830’s by an astronomer, mathematician, and sociologist named Lambert Adolphe Jacques Quetelet.  We have been using this antiquated measurement for years. There has been talk of using other measurements such as muscle-fat ratio, measuring body fat, waist to height ratio, and waist circumference. NUMBERS NUMBERS NUMBERS!! 

All are numbers trying to quantify something that is so complex but still very simple.  What is complex is that every person is different and needs individualized care based on who they are.  What is simple is that we know that eating a diet low in fat and salt and exercising on a regular basis helps with improving your mood, strengthening bones and muscles, increases energy levels, and decreases risk of chronic health issues like diabetes, hypertension, etc.  

Patients with obesity have become just a number, a data point, a target to meet.  A patient who has the “correct BMI” is deemed healthy and a patient whose BMI is elevated is deemed unhealthy.  We as physicians need to wake up and realize that obesity is not the enemy. We are not waging war with a number;  we need to fight to educate and encourage our patients to live a healthy lifestyle no matter what the scale says.  

We need to wage war with a lifestyle of inactivity and unhealthy eating.  It’s so easy as providers to place the blame on our patients. But what happens when our patient is eating right and exercising 5-7x a week and still their BMI is not “at goal”?   Have they failed? Have we failed? It’s so easy to be focused on a number as a finite definition of our success or our patients success. However, if I have a patient that is active 5-7 times a week consistently getting their heart rate elevated to goal, if I have a patient this is eating a healthy and varied diet I deem that a success.  

Patients want to be treated as more than their weight, more than a number.  While it is important to educate on a healthy lifestyle this message should not be the “sermon” for those deemed unhealthy by an arbitrary number.  We owe all of our patients a full workup and assessment of their health concerns regardless of their BMI. While obesity is a risk factor for many medical issues, we in the medical field must provide more than just “lose weight” as a response to every health concern.

Kharia J. Holmes, MD is a mother, daughter, sister, friend, and internal medicine physician who lives in Maryland. She enjoys making patients and others laugh because laughter is truly the best medicine. Her ImPerfect Life and Shenanigans can be caught on Instagram @TheImPerfectMD and her thoughts, fashion, and life story can be read on her blog www.TheImPerfectMD.com

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