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Illustration by Brittany England

Content note: This piece contains mention of eating disorders and fatphobia

Certain childhood events, seemingly insignificant, can imprint details on your brain forever. For me, it was going to the nurse’s office at the beginning of my middle school year. As I stepped on the scale, I would stare and memorize the columns and numbers on the multicolored charts right in front of me, as if they were math formulas or history facts.

I was only 12 years old, which was old enough to know that there were rules about which parameters, as a woman, were acceptable and which were not — especially when it came to size. Those rules, once implicit, were suddenly made explicit by the chart in front of me, a body mass index graph (BMI).

Conversations around body positivity or body neutrality often revolve around clothing size, the concrete number on a scale, or the constant body-shame associated with social media use. But another metric, the commonly used BMI chart, seldom enters the conversation.

It’s incredible that a metric from the 1800s still has such a profound effect today, especially when BMI affects risks of misdiagnosis and treatment for everyone — including children — despite folks who are ignored by medical professionals who fail to address and treat those struggling with eating disorders.

This chart supposedly determines whether you’re underweight, healthy, or overweight based on an individual’s amount of body fat. It didn’t matter that our bodies in middle school were still very much in flux, that the chart couldn’t tell who was throwing up at lunch and binge eating later. It didn’t matter that the chart won’t differentiate muscle weight as opposed to fat.

The chart was fatphobia disguised as health, which became normalized and ingrained in every decision I made. At 12, I began doing crunches in my bedroom after dinner to get rid of what Seventeen Magazine called “love handles.” I asked my parents to pack my lunch so I didn’t have to eat the chicken nuggets served at school.

Even when the charts weren’t on the walls, I would be looking at the charts at home online, trying to determine whether my weight was “good” or not. I would let out a deep exhale when the number reflected that I was in the “healthy” category. This rainbow chart consoled me whenever it stated I was within a “healthy” range — until I got to college.

Moving away from my mother’s home cooking to a different lifestyle caused a weight gain that spurred me to work out 6 hours per week (because when you’re in college you have the kind of time to spend on perfecting cardio routines).

This was also during the post-Tumblr pro-ana age in 2014, where the common “empowering” message was that the number on the scale didn’t determine health. I refused to own one in my dorm room, but the BMI chart still hovered in my mind. Any worries about my body were assuaged by the fact that I could still fit into the same clothing.

I might not have registered any overwhelming pressure to be skinny, but I didn’t think I had a self-esteem issue either. In my mind, the desire to be thin equated with good health. For others, relying on BMIs may cause psychological and even financial ramifications on their lives.

I spoke to other women in their mid-twenties, and the dreaded BMI chart is also seared into many of their memories as well.

In response to hormonal weight gain as a teen, one woman’s family “responded with fear” that she wasn’t working out enough or eating well enough. Her siblings told her she would never find love or be happy if she didn’t shed the weight.

These “well-intentioned” comments led her to a “healthier” kind of lifestyle, one where she limited each food group until her bones jutted out and her hair fell. She checked her BMI number every day, telling herself she was preparing for a healthier, happier future. Her family congratulated her.

I’ve gotten stories about women who won’t eat before heading to a doctor’s visit because they’re terrified of tipping over into that “overweight” range. Women whose doctors never detected their bulimia or anorexia because all they were looking for was a number that fell into the “underweight” category. Lifelong athletes whose worlds were forever changed when their muscle mass deemed them “obese” on a chart.

Although the term orthorexia was introduced in 1999, medical and psychological professionals did not propose to standardize formal criteria for the eating disorder until 2016. As of publication, orthorexia still is not recognized by the American Psychiatric Association or listed as an official diagnosis in the Diagnostic and Statistical Manual of Mental Disorders.

Now in my mid-twenties, I still refuse to have a scale in my apartment. My waistline and hips busted out of that lower-size range barometer I set for myself a long time ago, changes from hormonal (birth control) and lifestyle changes.

I work out two to three times per week and eat moderately healthy, but I still found myself gasping (internally) at the scale at my most recent checkup. It was an instinctive reaction, based on the BMI numbers from the seemingly insignificant childhood event.

While we know how inaccurate the chart is for determining health, finding other resources can be just as difficult. I spoke with registered dietitian and nutritionist Maya Feller for her take on modern tools for healthcare.

Feller does not use BMI as a metric for health, stating that “the calculation does not take muscle mass, bone density, or body composition into consideration.” And she goes on to explain that it’s not an evaluation that gives any indication as to what is going on internally.

Instead she looks at routine lab tests, inclusive of blood count and blood chemistry to diagnose the presence or absence of a disease. She uses a “patient-centered, culturally sensitive” approach to her practice, which means that the patient’s health related stories and socioeconomic status is brought into the fold when examining their health status.

In a study conducted in 2005 to 2012 by the International Journal of Obesity, they evaluated blood pressure, cholesterol, glucose, and insulin resistance in the participants. Fifty percent of “overweight” and 29 percent of “obese” participants were deemed healthy by these standards, while over 30 percent of normal weight participants were found to be unhealthy!

If we went off of BMI alone, so many individuals would be misclassified and given inaccurate treatment to improve their health.

Feller also acknowledges her own biases and internal assumptions when treating her patients to deliver the best individualized care for them. She knows it’s instinctive, as it’s human nature to make assumptions about a patient as they walk in, so instead she practices “working to meet them where they are” in lieu of trying to fit someone into a one-size-fits-all mold to provide equitable care.

While I wish more medical professionals followed in Feller’s footsteps, it’s also necessary that we don’t impose rigid rules on ourselves.

BMI, weight, and health are not guides to happiness. The real secret to being your best is finding acceptance in all of you, and listening to your body for what it needs.

I actually look forward to going to my primary care doctor these days, as she gives me an in-depth run through of my chart based off of blood and urine samples to tell me what I’m doing right and where I can improve. Despite my BMI number, I find relief in knowing that all my organs are working perfectly.

I don’t feel pressure to be skinny most days, because I know that skinny does not always mean healthy. There’s no shame in wanting to be happy and healthy, but it’s important to remember that size is not a panacea either. Happiness and health are goals that can manifest in many forms — often most invisible to the naked eye.

Ondine Jean-Baptiste is a freelance writer and communications specialist based in Brooklyn. When she’s not oversharing on the internet via Twitter or Instagram, you can find her binge-watching Master Chef, making a mood board, or telling anyone who will listen she’s a native New Yorker.