In order to receive an eating disorder diagnosis in the UK you need to be assessed by a trained professional and meet certain criteria. I’ve talked about this in a previous blog post. In that post, I examined the three more common eating disorders.
For Anorexia Nervosa, one of the criteria for this eating disorder diagnosis is that the person’s Body Mass Index (BMI) is below a certain level. In this post I want to explain why I think it’s inappropriate to use BMI as one of the criteria for an eating disorder diagnosis.
Eating disorder diagnosis
Although I’m a Psychologist working in mental health, I’ve never worked specifically with individuals with eating disorder diagnoses. I therefore want to make it clear that this post is my personal opinion as someone who has struggled with disordered eating.
Another ‘caveat’ is that I never received a diagnosis of Anorexia Nervosa. Years afterwards, when I’ve reflected on my experiences, I believe I met all the criteria for Anorexia Nervosa based on my behaviours and mindset. All apart from the BMI, that is.
And this is why I feel there’s a problem.
The scale lies
I recall an experience early into my eating disorder. A family member noticed I’d lost some weight in a relatively short period of time. I was booked an appointment with my GP without my knowledge.
This angered me greatly because it felt as though control was being taken away from me. Nonetheless I went to the GP. The story I gave was that I’d deliberately been losing weight, but that I’d now stopped.
The GP asked me to step on the scales. I wasn’t underweight. I was deemed okay. And that was that.
Leaving the GP surgery, the whole experience left me feeling even more angry. The GP had taken my story at face value. I was not deemed to be underweight and therefore I was “okay”.
In fact, I was far from okay and nobody was any the wiser because I looked physically “normal” and healthy. Nobody had “dug deeper” to hear my story.
Eating disorders are a mental health condition
I think it’s pretty widely accepted now that eating disorders are a mental health condition, as opposed to someone “wanting to be thinner”. There’s a lot more going on.
In fact, eating disorders have the highest mortality rate among psychiatric disorders.
This is why I question why someone’s weight to height ratio is a factor included within an eating disorder diagnosis such as Anorexia Nervosa.
Here is a good example of someone who wasn’t listened to, all because of her BMI.
Now, I understand that if someone is measured by their BMI as being extremely overweight or underweight, this may mean they need inpatient treatment. However, when someone’s weight falls within an average range it seems as though the possibility of them having an eating disorder is discounted totally.
I think professionals and the general public alike need to be more aware.
My suspicion is that there are many people out there who have an average height to weight ratio who have disordered eating and are suffering in silence.
This means that many people not receiving support for their difficulties with food. People need to look beyond what’s on the surface and find out what’s going on underneath.
If you do go to see a medical professional and they dismiss the possibility of you having an eating disorder, I’d recommend seeking a second opinion, and a third if need be.
Your health is worth fighting for and you deserve to be heard. Be as open and honest as you can be about what you’re experiencing. This means the professional has as much information as possible on which to base their decision about the next steps.
Have you ever been turned away from getting the relevant support because you didn’t fit a certain criteria? What’s been your experience?
Let me know in the comments.
Welcome! I’m a Psychologist and fitness enthusiast. My passion is supporting people with their health and wellbeing, and inspiring them to pursue the things they love doing. Please contact me at firstname.lastname@example.org if you have any questions or want to collaborate!