Attention: women! You might be fat without even knowing it!

According to this charming article which has been lurking about the internet for a few weeks now (several decades in internet time, I am aware), a full quarter of women who are overweight perceive themselves as normal.

Oh, and this is a problem. A terrible, terrible problem, because all of those women? They might not know about all of the horrible health conditions they could be suffering from right at this very minute! These women might even be eating a normal amount of food and not starving themselves, because they don’t even know that they’re disgusting, sick freaks of horribleness possibly maybe kinda unhealthy. Maybe. Because, of course having a BMI over 25 automatically makes a person unhealthy than their 24.9 counterparts. Because a woman could never know herself if she is healthy or not. Because the only way to be healthy is to eat a restricted diet. Because, of course, a person who is overweight can’t be normal.

But less of the snark, and let’s get to actually looking at the article, shall we? Most of the article focuses on the fact that a reasonably large proportion of women feel themselves to be in a different BMI category than they are. Some women who are ‘overweight’ see themselves as ‘normal*’, and vice-versa.
Okay, fair enough. Not all of us have the time or the inclination to constantly check our BMIs. We might be more interested in how our bodies feel and look to us than how this relates to a height-weight ratio that is, frankly, of very little use on an individual level. We might be busy with actually getting on with our lives and have different priorities.

But then we get to the discussion, to what is talked about, what is left out, and how topics are actually discussed. While the research itself appears to have included ‘underweight’ as a category, this article defines ‘normal’ weight as a BMI under 25. Can anyone else see the large, glaring problem here? Particularly when being severely underweight comes with rather more acute health problems (actual starvation) than being equivalently overweight (claims that certain chronic conditions are more likely which, contrary to popular opinion, are frequently contested).
When contrasting unhealthy behaviours among people who misperceive their weights, there also seems to be an imbalance in discussion in this article. While ‘normal’ weight people who perceive themselves as overweight are more likely to smoke or take diet pills- both activities which are dangerous in themselves- those who are ‘overweight’ might simply not be restricting their diets. How… terrible?
Later, however, we get to the really peachy stuff**. The last section of the article talks about how the ‘fattening of America’ could be causing people to feel themselves to be ‘normal’ when they are really abnormal ‘overweight’- how seeing other people of similar weights around them causes people to normalise higher weights.
Leaving aside that this is problematised? Again, okay, fair enough. I can see how seeing people like you around you would lead you to think that being like you is pretty much normal. However, let’s go back to the numbers, shall we? Some back-of-an-envelope calculations give me, in this study, 22% of ‘overweight’ women seeing themselves as ‘normal’, and 16% of ‘normal’ women seeing themselves as ‘overweight’. While there is a disparity between the two, I’m going to guess that it isn’t a hugely significant one***. It’s around the same range, ish. Oh, and no numbers at all are given for women classed as ‘underweight’. Surprised?
Which is where we go back to the problematisation of ‘overweight’ women perceiving themselves as ‘normal’. There simply isn’t an equivalent problematisation, in this article, the other way around. It’s not there. The idea that there are every bit as significant a fraction of women who think themselves to be ‘overweight’ when they’re not? The fact that we’re shaming women of all sizes into behaviours that are both unhealthy and damned un-fun in the pursuit of a certain body type, and then writing damning articles about them when they have a healthy self-image? Not there either. And all of this without even a mention of the 49% of the human race left out of this discussion entirely.

There’s just one more thing I want to talk about, regarding this article and the women it criticises. And that is that it appears to me that one of the people they’re talking about here? The people they’re criticising like this for not restricting their diets and being suitably ashamed of their bodies? Is me.
See, I did some calculations over the past few weeks after this article came out. It turns out that my BMI? Varies between 23-ish and 25-ish. If I’m feeling a bit bloated, a bit on the PMSey side of things and happen to have eaten recently? If I’ve decided today that I’m probably closer to 5’2″ than 5’3″? I could, without even noticing, cross that great divide between Normal and Abnormal Overweight, between Healthy and Should Be Starving Herself. Today? I have no idea, and I have no interest in getting on the bathroom scales and taking out my calculator to find out.

*Here I recommend tying a nice pillow onto your forehead to avoid bruising from the inevitable headdesking and facepalming. If you don’t happen to have any pillows of appropriate size, you should be able to McGyver something with, say, some nice thick socks and some string or elastic.
**You might want to make sure that pillow is firmly attached to your forehead before going any further.
*** Feel free to jump in here please, statisticians!

Attention: women! You might be fat without even knowing it!

6 thoughts on “Attention: women! You might be fat without even knowing it!

  1. 1

    I use the Wii Fit pretty often, which calculates BMI during every “body test.” It keeps telling me that my ideal body weight is somewhere around 10lbs heavier than what I am, but when I was that weight, and I lost 10lbs, everyone told me how GREAT I looked, and how SKINNY I was, and how GREAT it was that I was so SKINNY. It was unreal, and highly irritating. One more reason why BMI is so inaccurate when used on an individual level like that. And also how no one who congratulated me on losing 10lbs apparently saw my heavier weight as “healthy,” just chubby, or not ideal, or something.

  2. 2

    Actually the difference is significant. Small – somewhere between 3% and 10% – but significant.

    Of course, that doesn’t at all compensate for the flaws in the study design, the biggest being that BMI is really a pretty crude way of assessing health.

    1. 2.1

      Thank you for the statisticianing! How ever could you have guessed that I was incredibly-subtly looking for your input on this one? 😉

      And seriously, since when is BMI an indicator of individual health? As far as I was aware, it was the kind of measure that was only useful, if at all, when dealing with statistical trends in very large groups of people, right? Given that for individuals, there’s really no way of knowing how healthy a person with a given BMI is without, you know, being either them or their doctor.

    1. 3.1

      Hehe, so you have! And it’s true that by any sensible measure I don’t count as ‘fat’ to anyone but the people who measure BMI- I mean, there are clothes in pretty much every shop that are several sizes too big for me! Skinny-ish privilege like woah, there.

      More importantly, though, now I am craving gummi bears and all the shops are closed..

  3. 4

    I have fifteen different things to do and they’re all urgent, so naturally it is time to critique a study. With the admission that what I’m reading seems to be a journalist’s report on it and not the researchers’, so some of this criticism may be unfair.

    First off: yes, BMI is not the last word on individual health. If the study had taken every participant and assessed their height, weight, bone density, lung capacity, bodyfat percentage, and probably a host of other things too, they could have classified them as “healthy” or “overweight” (or underweight, obviously, but the absence of that category is a seperate issue) with greater accuracy.

    However, doing so would raise the cost per participant, possibly quite substantially, and result in a smaller sample size, so that was probably the justification for taking a crude measure.

    Because, yes, it is more useful for trends across large groups than for the individual – and that’s where this study is looking. Or, to put it another way, high BMI is not the same as being overweight, but it is a risk marker for it – some of those 1,162 were doubtless perfectly healthy and in fine shape and misclassified because muscle weighs more than fat and skeletons come in different sizes etcetera etcetera – but it’s pretty unlikely that all of them were! On a hunch, the “risk” of being genuinely an unhealthy weight might increase as BMI increases above 25 – as you point out, the difference between 24.9 and 25.1 is trivial, but the difference between 25.1 and 35.1 is not, so much.

    So. If I was doing this study and had been told that no, we can’t do anything more precise than BMI, I would probably have had participants respond to statements like “I am a healthy weight”, a whole range of questions actually, with a scale from “strongly disagree” to “strongly agree”. There are then methods of analysis which would allow for more precision in looking at the relationship between BMI and perception of own weight, while controlling for other factors like age and education and all the usual suspects. That would also mean you could skip over the issue of 25 bad. (I won’t go into them in detail. I’m kind like that.)

    The other thing that jumps out is this line:
    “The overweight women who thought they were normal weight didn’t cut back on food intake, for instance. The normal-weight women who thought they were overweight were more likely to use diet pills or diuretics or smoke cigarettes.”

    This seems to be putting two different not-ideally-healthy things on the same footing. An overweight person who goes on eating big dinners is perhaps not acting completely in their own best interests, but eating dinner is basically a normal thing to do and there’s nothing intrinsically wrong with it – you’d do it whether you wanted your weight to go up or down or stay exactly the same. Whereas taking diet pills or (diuretics? Surely they mean laxatives…?) strikes me as something people just don’t do unless they are trying to lose weight and even then, it’s not exactly something your doctor would recommend, I don’t think.

    So there you go. Congratulations to anyone who waded through all that.

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