Tag Archives: BMI

My Recent Presentation at the AHSNZ Conference Wanaka October 2014

Hi all – very sorry for the lack of recent posts. Busy teaching this semester!

Recently I participated in a very cool conference hosted by the Ancestral Health Society of New Zealand. As well as being in Wanaka (the best place in NZ, except for Palmy of course ;-)) it was literally teeming with interesting presentations on all sorts of subjects, from fascia (Matthew Stewart) to mental health (Dr Greg Brown) to the intricacies of endurance training (Jamie Scott). Here I post the slides and text from my presentation – please feel free to share widely.

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I don’t need to tell you where we have got to with regard to body image and the current ‘acceptable’ images of body in New Zealand.

This recent example of the clothing company Glasson’s using a mannequin with visible ribs highlights the body goal of the fashion and diet industries. Don’t get me wrong, there is nothing inherently problematic with ribs – I love ribs. But the imagery and the impact are wholly understated given the context of the population frequenting the store.

In this presentation I want to talk about body mass and endurance athletes, specifically I want to trouble our society’s current understanding of the relationship between mass and endurance within the context of an ancestral understanding of body. However I want to read the term ‘ancestral’ fairly broadly. I’ll start by explaining what I mean by this…

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A discontent of our current society is the tendency to read biomedical science as ‘Truth’ with a capital T (that is the only possible truth.). This naturalistic perspective privileges some things at the expense of others. For instance it privileges conscious thought over Unconscious thought. And it privileges the individual (and here I am referring to the molecular individual) over the collective. But perhaps most importantly for our concern is that it privileges biomedical scientific knowledge over what I’ll term philosophical knowledge. So, if we read this quote from a naturalistic perspective we understand certain things about our ancestors – what they ate, how they moved, what their environmental conditions were and the like. To take the ‘thinking critically’ aspect here seriously I believe it is incumbent on us to also respect our ancestor’s philosophy – their understanding of their bodies in context, as devices of physical labour, as Mothers, as leaders, as mystics and others. This vicissitude, this distinction, that sees biomedical and NOT philosophical bodies, is artificial, and in my opinion risks a simplification that threatens to undermine the emergent radical potentiality within the ‘ancestral health’ movement by sucking it into line with the ‘diet’ industry – i.e. just another fad. Which would be a tragedy. So in some ways what I have to say here is rather political, as a strident critic of the wider diet industry it is very exciting for me to be involved with a theorization of health that doesn’t want me to be losing weight.

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Ok – so just one more theoretical spiel before I’ll cut to the fun bit. So what are these critical philosophical concepts that I see underpinning the ancestral movement – well thankfully, only one. This comes via Nietzsche and then Foucault – this is the concept of genealogy. Which is not the study of one’s ancestry but a form of enquiry that, and I’m quoting here “seeks to show the plural and sometimes contradictory past that reveals traces of the influence that power has had on truth”. Specifically here I present some ideas on a geneology of the BMI measure, how has this become the ‘truth’ – and what are the facets of this truth, how does it work as a device of power? I do this via what distance runners say about body size.

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It isn’t difficult to find bloggers and others promoting the exploits of Scottish highland warriors (I’m not talking specifically about Braveheart here – but you get my drift!). But plumbing my own Scottish ancestry seems like a useful beginning, and a necessary intrusion, to considering what has changed in the last few hundred years with regard to perceptions of body mass.

My entire heritage is Scottish, except perhaps for a little northern English infiltration. And in my family runs a heavy mass set of genes (I say ‘set’ on purpose because so far at least ‘science’ is pretty rubbish when it comes to figuring body mass genetically). Thus I have a set of cousins and others who are all ‘of mass’ and a set who are a little littler (including my brother). Losing weight has always been a problem for this segment of my family, though it’s fair to say that I’m pretty good at it. Top weight ~140kg, lightest around 88kg now somewhere in the vicinity of 105kg (if you want to read lots about my personal experiences I’ve published three journal articles so far that tackle different aspects of this)

The odd thing about the bulky line in my family is our relative sporting prowess at least in distance running, peculiarly. My last half marathon was 1:45:00 at 107kg and 180cm.

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So the science is pretty definitive on endurance running performance. The number one factor that impacts on performance (as measured by speed) is body size. The larger you are the slower you run. In fact the physics are pretty simple (read the papers if you want the detail). Age has an effect also – but it isn’t as pronounced and there are some oddities, like men often get faster between the ages of 30-50 (which tends to piss off the young men!).

Now the scientists behind this research have developed a calculator whereby you can adjust your running performance based on your body size age to allow accurate comparisons.

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So here you can witness my failure. My PB half marathon is 1:35:55 posted in Manawatu in 2006 when I was 88kg or so and 30 years old – when calculated for size and age my adjusted time is 1:24:26. Fast forward 7 years, one master’s degree, one PhD, two kids including one with rare genetic disease and birth trauma, and no less than 10 fairly awesome running injuries and I run again in Manawatu and cross the line in 1:45:flat (10 mins slower, sigh). But I’m saved by the calculator – when adjusted for my then 107kg mass: 1:23:05.

Ok – so theatrics aside, what this data proves (and my two times are simply two examples of thousands used by the researchers) is that body weight makes a difference – My guess right now is that no one in this room is even remotely surprised, right?

So what happens when we asked 1000 NZ marathon runners whether they thought that endurance races should have weight divisions?

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75% unsupportive or very unsupportive

10% are ambivalent

15% supportive

Ok – so the assumption must be that the 15% in support are the big heavier runners?

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Yes, this is exactly what we see – as body weight increases so does support for weight categories, the correlation is 80%, which is strong.

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But when we run those figures by Body Mass instead the correlation disappears, in fact it disappears because this very significant drop from generally supportive to generally unsupportive between the categories of ‘overweight’ and ‘obese’. Now please remember that those runners in the ‘obese’ category still can run 42.2km in one go – nothing to be sneezed at, they are very fit, very dedicated people, just larger than average people.

So what exactly is going on? We have this anomaly – larger people with BMIs over 30 don’t support weight divisions, whilst larger people with BMIs between 25 and 30 generally do. It seems for runners we can ignore ‘overweight’ mass but not ‘obese’ mass. In fact here we can see the power of the BMI as it determines how people understand the ‘truth’ of their bodies, regardless of how they consciously reject it.

So in the next two slides I’m going to show you two small pieces of data, separated by 20 years or so that provide a snapshot from the perspective of the endurance runner on body weight.

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I’ll leave you alone to read this quietly – written in the early 1990s ‘Oversized oafs’… ‘blubberous blimps’… ‘hefty hippos’ which is your favourite alliterative genius?

In fact this type of vitriolic reaction is totally common in road running events (not in mountain running interestingly – I have a pet theory on this – but no time now to explore it). Laura Chase, a U.S. based academic interested in weight divisions in running even uncovered this as a factor in the suicide of one of the first proponents of this idea. This is what NZ runners said.

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The first ‘camp’ of reasoning (and I hesitate to call this reasoning) suggests that there is a significant danger within the recognition of weight divisions, as it apparently ‘sends the wrong message’; after all we wouldn’t want them to belong!

The second ‘camp’ presents the sport as an individual enterprise, in fact so individualized that there is no competition except competing against your-self.

The third ‘camp’ recognizes that larger runners “should be allowed” (which is actually fairly representative, in fact quite a few suggest there should be checks in place to prevent larger runners from participating – due to their supposed risk profile). But that they themselves would react very very badly by being classified by weight – this is more prevalent among women, because heaven forbid there is ever an official public record of the number on the scales!!

Ok… so what how can I theorise this reaction within the philosophy of genealogy in ancestral health? More interestingly – how can a philosophy of ancestral health, or perhaps more fittingly ancestral hauora become a kaupapa for re-thinking body mass in endurance running. I have only two slides left – I’ll first tackle the theory-side and then some learnings.

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So the problem with the Other is actually a feel simple one – and an ancient one. Philosophically this dates back as far as we care to go, Plato’s cave for instance. The issue that confronts us is that the Other lives in us – we are constructed from it, via the twists and turns of language acquisition. The things we fear the most are habitually part of us.

This results in people habitually resisting any mechanism which grants legitimacy to something that might empower the Other, despite their desire. The irony is that this resistance is one side of a coin – it ‘simply’ needs a flip to become reality. That flip is the movement from fundamentalism to pluralism.

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What is the utility of a body? What is the function of a body? – Here we can take a steer from the demands of the environment. Having a body ‘fit’ to work is a functional demand, and one that is very easy to moralize into a particular physical environment. We also need bodies that have utility socially – what does that look like now? (I acknowledge my new found colleague Adele Hite for the image on your right – her presentation to the Ancestral Society in the U.S. in 2013 is fascinating!)

Size does not equal health. Skinny is a modern (or perhaps a post-modern) neurosis. This does not mean that skinny people are neurotic, but that the overwhelming desire for skinny creates neurotic behaviour. Thus the meme that follows Kate Moss around “Nothing tastes as good as skinny feels” is in fact representative of our society’s discontent with body size. My challenge to that, aside from the obvious challenge posed by bacon, is a challenge for all those who think ancestrally to think in plural and allow contradiction to exist without seeking to placate this with some sort of overarching truth, a fundamentalist truth. Instead work with people, of any size, to recognize their utility and function – whatever that might be.

One thing that Adele Hite has suggested is whether this could take the form of an alliance or relationship to the Health At Every Size (HAES) movement, which seeks above all body acceptance. Now, while very supportive of the respect of all bodies, I’m also cautious – due in part to some significant concerns raised by a sociologist colleague Deborah Lupton, for instance she states that HAES “reproduces the classic Cartesian duality of the mind/self as separate from the body/flesh and turns it on its head. Instead of the rational mind positioned as superior to the fleshly body, here the body is represented as ‘wise’ and all-knowing, to which the mind/self should relinquish control. Yet as theorists such as Merleau-Ponty have argued, we cannot separate ‘self’ from ‘body’: we always and inevitably experience the world as embodied selves”. But on balance I think it is a good idea. However what about an alliance with desire? A most ancient driving force I’m sure you would agree? For me at least a tenet of ancestral health involves respecting desire – which I think seems very logical within the philosophy? And certainly a significant point of departure from the diet industry.

Thanks.

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The Evil of the BMI Calculator

Today I was trawling the web for a BMI calculator to work out Richie McCaw’s Body Mass Index measure (Richie is the captain of the All Blacks, we love Richie). His BMI is around 30 it seems, just obese – well done Richie! Anyway I came upon this calculator provided by the Australian Heart Foundation. It is notable because it also provides a useful (oh wait, I mean useless) diagram of what you must look like. So I plugged my height and weight into the boxes and here is the lovely response:

Image So I thought I would post a photo of what my body actually looks like (sorry – couldn’t bring myself to do the nude shot):

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and no… I don’t do weights, go to the gym or anything else silly like that. I just run as much as I can fit into my schedule. So my message to the Australian Heart Foundation is pretty simple – take down your stupid, abusive, misleading BMI calculator with the added ‘fat bastard’ image generator. It is offensive, plain and simple.

 

 

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Circular Arguments: Even More on BMI and Obesity

I subscribe to a email out of the latest ‘news’, ‘views’ and ‘science’ related to obesity research. This grouping is provided by David B Allison and colleagues at the UAB Office of Energetics and comes out each week. Here is the website. It’s kind of informational, kind of judgemental, to be honest its one of my guilty pleasures! It is really fascinating to read through this, often because of the odd titles and formulations, and of course for what they choose to include. This week I clicked with keen anticipation on this link:

Because, you know, I’ve written a bit on this exact topic once or twice. The actual linked article is a fairly standard kind of example of a ridiculous extreme approach by a health practitioner, instead of using her eyes she used the measure (the BMI that is). This isn’t a new story, in fact it happens every day all over the world. What I wanted to do is to draw attention to the circular link inherent in the title above, particularly:

Reminder: BMI is a crude proxy for Obesity

As I have pointed out many many times before, BMI is the very basis for the definition of obesity, how then can the very basis of something also function as a ‘crude proxy’ for it? This is non-sense, but is the common non-sense that is used uncritically by almost everyone working in this field.

The fact is that the signifier ‘obesity’ has become fully detached from the Reality of the mathematical formula that provides its very foundation. So when a health professional interacts with the term ‘obesity’ the only ‘official’ way they can do this is via the BMI, though they are cautioned or demonised for doing this. As I have said prior my suggestion is to completely abandon the terminology in health practice and instead consider the desire of the person sitting in front of them – what do they want?

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What weight anxiety looks like

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I’ve been having an ongoing knee issue lately. Basically it seems like I have an injured tendon. Very local, not very painful, but enough to be seriously frustrating. My physio referred me to a specialist for a treatment plan, as part of this guy’s assessment he asked me to step on the dirty scales. Now the weight was normal, nothing particularly unexpected, but the consequent BMI calculation reinforced my ‘obese’ status. He then proceeded to rally on about the stupidity of the measure etc… I just heard “blah, blah, blah”. I mean it’s not like I haven’t heard it or said it before eh? We all have. All Blacks blah blah, big boned blah blah, efficient metabolism blah blah. Blah fucking blah.

I don’t give a shit if the measure is stupid, it still gives me a label a have to wear every day. The result: I found myself buying tofu… that is what my weight anxiety looks like this week 🙂 Thanks Anna for pointing out out!

Now I have to eat it.

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Obesity = disease? #iamnotadisease

On the 18th of June the American Medical Association (AMA) officially classified obesity (as defined by the BMI) as a disease. This decision ran against the advice of the AMA’s own advisory committee on the matter; their Public Health and Science committee advised the AMA to not classify obesity as a disease. The decision has caused immediate and ongoing anger amongst many groups, including fat activists, the HAES movement and financial commentators. Few seem to support the decision, citing the ridiculousness of the BMI measure and the medicalisation of what is general very normal as the main factors. Here are links to just a few of the many critiques of this decision:

From Kath Read, a personal and poignant account.

From Ragen Chastain at the amazing blog Dances With Fat

From Runner’s World – a surprisingly insightful, but fairly mainstream commentary 

From Forbes on the boost for Big Pharma

Rather than adding to these with my own analysis, I thought I would see what New Zealand’s Medical Association (NZMA) might have to say. Nothing, at least I can’t find any commentary on their website or on the web. So far so good, at least in New Zealand people with a body mass index score over 30 are not automatically diseased. Anyone with a clear head must realise the stupidity of using body mass as a classification device, it simply defies any logic, aside from the logic of rampant capitalism that is. If I was one of the poor souls subject to the american health system I would have been born diseased, and lived virtually all of my life as diseased. In fact the only time that I was not diseased was for about year during my absolute worst mental health phase as I attempted to live a life akin to anorexia: Medicated, obsessed, miserable. But the capitalism practised by the large multinational pharmaceutical companies is rampant, they subsume all they see, they have to own entities like the AMA because these gift Big Pharma the providers and consumers of their pharmaceutical products – it is basic vertical integration, just good business sense.

In many ways New Zealand is immune to this stupidity – we have Pharmac, a state entity responsible for making sure that NZ citizens and residents get access to drugs as cheaply as possible. It works, it’s great, and best it is almost impossible to influence via financial means. Of course access to pharmaceuticals in NZ can be influenced by lobbying, as was the case with the breast cancer medication Herceptin and to some extent via direct marketing to medical professionals, but the extent is substantially less than in the U.S.

In my view the immunity offered by Pharmac gives the NZMA a unique license to focus on the fundamentals of medicine, which for me is about the requirement to ‘do no harm’ and the requirement to practice science not capitalism. This means I would expect the NZMA to reject the clinical definition of obesity by BMI wholesale, as the science is increasingly demonstrating that it is profoundly and fundamentally flawed. This of course would lead to more work by the medical profession, as they would have to look at health holistically, but this is the burden of science. If the hypothesis proves to be false (BMI greater than 30 = poor health) then accept the evidence and develop a better hypothesis. Sadly the NZMA has just followed the rest of the world and continues to use the classification ‘obesity’ without any adequate consideration of the science.

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The Other Side of the Body Mass Index (BMI)

Measures are dastardly beasts. They appear so objective, so barren of error, so telling. They are used everywhere, on everything, they are supposed to represent the truth. But measures have an ‘other side’, they tell only part of the story, they skip along the surface of deep structures, they are a veil. The Body Mass Index is such a measure; it is a veil that rests upon the face of the ‘obese’, a heavy veil; one that obscures the structure underneath. The BMI reduces humanity; it leaves only a remnant that accentuates a very particular view of physicality, the rest of humanity’s features become opaque, their value reduced so that all that remains is simple biomass. Many would argue that it is only a ‘rough’ measure, one that we shouldn’t read too much into. My contention is that this argument does not recognise the other side of the BMI, specifically: its place in the social unconscious?

The unconscious is a problem for science; it has been since Freud first made his discovery near the turn of the 20th century. At best science suggests that it is not a useful concept, because of our inability to measure it and at worst science simply refuses to accept its existence. Neither of these approaches is good enough, I want to understand the structure and function of the unconscious; I want to know what it means for humanity.

Through the process of my research and particularly my engagement with the philosophy of Jacques Lacan, I have come to understand three things about the unconscious; these are not overly complex but are essential for understanding the other side of the BMI:

  1. The unconscious is a social thing; it is shared by members of cultures. This means that people who have been raised in the consumer obsessed ‘west’ share a certain ‘knowledge’ about things like grooming, body size, eating habits and the like.
  2. The unconscious is a language; its meaning is carried by words, and as we know meaning is a fleeting thing. Chinese-whispers reign in the unconscious also.
  3. The unconscious has no time; the feelings it produces feel as intense right now as when we first experienced them. It is where post-traumatic stress resides.

When we speak to other people our language conveys both conscious and unconscious things, we cannot help this. Words and phrases have different meanings consciously and unconsciously, they produce different affects. For example if I hold up a finger and thumb and say “bang” to a little boy he laughs and runs away. If I did the same thing to a war veteran the response may be rather different. Our histories carry our reaction.

This is exactly the same for the BMI. For many the names ‘overweight’ or ‘obese’ carry so much more than what appears on the surface. I have never been in the ‘normal’ weight range of the BMI, I was not even normal when I was born at almost 11lbs. I wasn’t normal as a 2 year old sitting on the 100th percentile for body weight, and I wasn’t normal in 2007 after completing the Kepler Challenge in just under 8 hours, I wasn’t even normal after losing almost 45kgs in 2006. On the surface it is easy to say ‘don’t worry about it, it’s only a rough measure’ but when you have not been ‘normal’ your entire life, this is a different story. Regardless of my general health or my ability to run marathons or my role as a husband and Father, I am obese, for the BMI tells me so.

That is the other side of the BMI; the other side is what it means in the social unconscious. Its simplistic formula transmits ‘knowledge’, through Chinese whispers, throughout the language of the unconscious. The results are scandalous: To be obese is to be fundamentally bad, to be morally repugnant, a blight on society, a health burden, mentally unstable, uncontrolled, lazy, child-like. These are the affiliations that exist in the language of the social unconscious, even if we actively and successfully screen them from our individual conscious thoughts they remain in the social unconscious and will do until as a society we stop talking about the BMI as a measure of any individual.

My goal is to see the BMI relegated to its rightful role as a simple statistical measure of a total population (not a measure of population health, just a measure of population) like ethic background, income, or eye colour. I want to see health professionals stop using this lazy measure entirely and instead become more holistic by considering a wide range of health related information including at minimum: nutrition, physical activity, biochemistry and psychology when advising individuals on their health.

Although this seems like a fairly simply request, it is not easy – because the use of the BMI is rampant. I hope that exposing the ‘other side’ will go some way to show how painful it is for weight anxious folk like me.

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