We have, as a society, such a completely disordered, distorted perception of female bodies that the vast majority of people are incapable of recognising what “overweight” actually looks like on a woman, let alone “healthy”. As such, we’re now at a point where women are not only raised to hate their bodies as a matter of course, but are shown, from childhood, a wholly inaccurate picture of what they “should” look like – a narrow, nigh on impossible physical standard they are then punished, both socially and medically, for failing to attain.
I don’t say this lightly. I say it because this is the only conclusion supported by the facts.
Let’s examine the evidence, shall we?
Overwhelmingly, the measurement used to determine whether or not someone is a “healthy weight” is the BMI, or Body Mass Index. Most people are still taught it in schools; indeed, it’s commonly used by doctors and in medical underwriting for insurance purposes, and is also used by the WHO and various other official bodies, including many universities. It is, however, flawed to the point of uselessness – a fact acknowledged by the man who popularised its usage, Ansel Keys, who explicitly stated that it shouldn’t be used as a tool for individual diagnosis.
There are several main reasons why our cultural reliance on the BMI as a means of assessing health, and particularly women’s health, is deeply problematic:
1. It doesn’t take into account the fact that muscle is denser than fat. As such, it frequently registers athletes and bodybuilders as being obese or overweight, despite their incredible fitness, just because their bodies have greater muscle density, a prejudice which extends to anyone with significant muscle-mass. This is why, for instance, a superfit bodybuilder, Anita Albrecht, was yesterday told by an NHS nurse that she was obese and ordered to go on a strict diet.
2. It doesn’t take height or bodytype into account with any degree of accuracy. Taller individuals will always have a higher BMI regardless of their actual weight, because of the way the measurement is constructed, while shorter people will always have a lower one. Having been originally developed in Europe, using European physical norms, in the 1800s, neither does it factor in ethnicity or metabolism, which is why a Yale University student, Frances Chan, is currently being pushed to develop an eating disorder by the college’s medical administrators, all of whom are so obsessed with her naturally low BMI that they’ve assumed she must be anorexic, and are forcing her to gain unnecessary weight or risk expulsion.
3. Although women are both shorter on average than men while naturally carrying more fat, the BMI calculation doesn’t take this into account, but uses the same measurement for both men and women. In fact, it was originally formulated based on studies of white male populations only - which means that BMI is fundamentally predicated on judging female bodies against male norms. As such, and as useless as the BMI is anyway in terms of individual diagnosis, it’s especially harmful to women and POC, whose morphology and metabolisms it was never meant to accommodate.
4. It doesn’t account for age, or any change in height that occurs with age. A teenager who hasn’t yet achieved their full growth or settled into their normal, adult weight is held to the same standards as someone old enough to have begun losing height
Combine these facts together, and you have a recipe for disaster. All over the world, women of all bodytypes, ages and ethnicities are being told by physicians, family members, universities and insurance companies to try and adhere to a single, “universal” notion of bodily health that is, in fact, predicated entirely on what was considered normal for white European men in the mid-1800s.
2. Clothing Sizes
Clearly, these women all wear different size clothes for reasons that have absolutely nothing to do with their weight, and everything to do with height and bodytype. But because of the fashion industry’s obsession with tall, thin, white, ectomorphic models – women chosen, not because they’re a representative sample of the population, but so their minimal frames can better serve as coathangers for clothes that privilege a very specific aesthetic over function – we have learned to correlate small sizes with healthy bodies, the better to justify their primacy on the runway, in advertising and on screen as a healthy ideal. Never mind that modelling agencies have been known to recruit at eating disorder clinics, with store mannequins more closely resembling the bodies of anorexic girls than average women, models eating tissues to stay thin and rail-thin models photoshopped to hide their ill-health and prominent ribs: because “plus size” models – that is, women whose bodies are actually representative of the general population – are treated as a separate, exceptional category, the fiction persists that “plus size” is a synonym for “overweight”, “unhealthy” or “obese”: women too enormous to wear “normal” clothes, even though the norm in question is anything but. As such, plus-size models are frequently derided as fat, a joke, unhealthy and bad role models. Today, catwalk models weigh 23% less than the average woman, compared to 8% just twenty years ago – yet whenever this disparity is pointed out, the reaction of many is to just assume that average women must be overweight, and that using plus size mannequins will only encourage obesity. Throw in the fact that women’s clothing sizes aren’t standardised, but fluctuate wildly from brand to brand – or within the same brand, even - and the idea of judging a woman’s health by what size jeans she wears becomes even more absurd.
For anyone still temped by the idea that the standards set by the fashion industry aren’t really that bad, and that the obesity epidemic is surely skewing statistics somewhat, let me put it bluntly: Eating disorders have the highest mortality rate of any mental disorder. Women aged 15-24 are twelve times more likely to die of anorexia than of anything else, while 20% of all anorexics die of their illness. So when I tell you that 20 to 40% of models are estimated to suffer from eating disorders, and that only 5% of American women naturally possess a model’s bodytype, I want you to comprehend my full meaning.
Think about that, the next time you’re tempted to call the girl in the size fourteen jeans overweight.
3. Fat Health
And here, we come to the nub of the problem: the ubiquitous conflation of slenderness with health. With all the statistics I’ve just listed, I shouldn’t have to point out that one can be fantastically thin – model thin, even – and still dangerously unhealthy: among their many other evils, for instance, eating disorders can lead to bone loss and heart complications, to say nothing of the mental health component. What’s much harder to convey, given the overwhelming social incentives to the contrary, is the idea that one can be fat – and I want to talk about that word more, in a moment – and still be physically healthy. Obviously, there are also health risks to being obese, and that’s still something worth discussing, especially given that 6% of deaths are attributable to obesity. But on a daily basis, our fear of this fact, when combined with myriad other social distortions - our obsession with an extremely narrow and largely unrealistic image of female beauty, the conflation of small clothing sizes with healthy bodies, our phobia of anything “plus size”, the false reporting of BMI as an indicator of female wellness – means we’ve lost the ability to tell what obesity actually looks like.
(One cannot help noticing that, while the WHO claims the number of obese persons has doubled since 1980, this statistical leap neatly parallels the adoption of BMI as standard by that same body, which also happened in the 1980′s. Given the appalling flaws of BMI as a system – flaws which not only lead to average-sized women being categorised as overweight or obese for failing to have male proportions, but which also award higher BMI’s to taller people at a time when the average person is getting taller – it’s hard not to wonder, therefore, if it’s not that we’re gaining weight in such massive numbers, but rather that the yardstick for obesity has radically shifted. At the very least, if actual obesity is on the rise, I sincerely doubt it’s rising as much or as quickly as scaremongers seem to think it is, given the undeniable skewing of data inherent to the BMI system.)
Particularly for women, possession of any visible body fat whatsoever is invariably conflated with being overweight or unhealthy, and while that’s true some of the time, what it means in a practical sense is that fat, as a concept, rather than being a simple bodily descriptor, has instead become pejorative, a warning that we need to amend our ways. We talk about fatness like it’s a single, static thing, rather than a relative term: as though, if you’re fatter than someone – anyone – you must also be fat absolutely. We don’t talk about degrees of fatness, or bodytype, or distribution of mass. We LOVE big breasts (provided they’re not saggy, of course, or possessed in the expectation that you’ll be able to buy affordable bras to put them in, which – surprise! – you can’t) and we talk, gingerly, about “curves”, but always in ways that serve to disconnect them from the type of bodies to which, more often than not, such attributes belong: fat ones. Because being fat isn’t the same as being overweight, or obese; it just means not thin, and if you think “overweight” and “not thin” are synonyms, then you haven’t been paying attention. Being called fat, in fact, is often just code for “not the ideal”, which can be down to any number of things – that you have wide hips, stomach rolls, thighs that touch (our obsession with the thigh gap is dangerous in and of itself; unless you have a naturally splayed pelvis, it’s only attainable via malnourishment). Our language is full of mocking, heavily gendered terms tied to particular bits of anatomy or pieces of clothing, all of them designed to police women’s bodies: cankles, cameltoe, muffin top, whale tail, tramp stamp, thunder thighs, junk in the trunk, saddlebags, child-bearing hips. As a teenager, I remember seeing a gossip magazine mock Jennifer Aniston for having “arm sausages” – little rolls of skin at the side of her armpits – and feeling physically sick as I realised I had them, too, and must therefore be fat.
We need to stop reinforcing this idea that if you’re not thin, you’re obese. As a concept, it has absolutely nothing to do with health, and everything to do with justifying our demand for idealised female beauty by mocking anyone who doesn’t meet its impossible standards as overweight. We need to stop relying on BMI to tell us how healthy we are, or not – especially for women – and accept instead that “health” is too complex a concept to be boiled down to a single calculation. Especially given the horrific biases in the healthcare system against anyone seen to be overweight, using a single glib rule to determine the most likely cause of unwellness is not only counterproductive, but dangerous. We need to stop using “fat” as a pejorative, and we sure as hell need to stop the toxic culture of eating disorders, photoshopped images and outright malnutrition currently fuelling the fashion industry.
Because society deserves better. Women deserve better.
We deserve better.