In the series on my fat-control, here’s a last set of comments on BMI, using the closely related height/weight charts doctors had as a gimmick before BMI. We can’t even estimate how many of us become sick, sicker or dead from physicians not listening, not believing.
Although they tend to say their anecdotal and experiential knowledge is sound “medical science,” it is a very rare doctor who trusts patients’ self-reporting. I recently experienced that repeatedly from two nurses, my PCP, and a nutritionist. Shown two years of carefully measured, counted, weighed and machine-derived caloric intake and exercise expenditure, to a one, they denied it all. I was yet another patient who was confused, or dishonest, or inaccurate, or unaware of what I was eating.
Instead, logic could go for Occam’s razor, looking for the simplest explanation that fits the known facts. In this case, I came to them because the two nutrition/exercise recording programs I had been using clearly indicated that I should have lost considerable weight instead of continuing to edge up. The conclusion I drew and expected them to was not that I had to be a liar or fool when my experience did not fit their formulaic stereotype of calories-in/calories-out. Instead, my metabolism might be hosed, my body was too efficient during exercise, and the estimated basal metabolic rate was wildly off in my case.
With my conclusions, I could try to work in that frame and find solutions short of absolute starvation. The best my doc could say was maybe I could increase my aerobic exercise 10 minutes a day. I was already exercising one to two hours six or seven days a week. His way was just silly.
It took me back to decades before, when I dealt with the guy I think of as Dr. Cadaver. He was a partner of my favorite doctor and specialized in smoking cessation and weight control. He was so gaunt that he appeared to have been dead for quite some time. I think that was good for his anti-cigarette work.
About that x-ray…
In fact, he did scare me. After a battery of what was then called routine tests, he said he wanted to talk with me about my chest x-ray. I had smoked two packs of Camels a day for years and dreaded the skeleton’s revelation. He asked whether I lived in Manhattan (I did). He paused a long time, leaving me to stew. Then he said, “That’s odd. You have the clearest lungs I’ve ever seen in a city dweller.” That put the idea in my head to stop smoking, while I was ahead.
I had complained to my doctor that I wanted to lose some weight. At about 190 or so, I wasn’t fat, he said, but he sent me to Dr. Cadaver.
The first conflict came from the exam where he questioned my checking large bone structure on his form. Like so many doctors and nurses before and after, he laughed derisively and with a snort said that everyone claims to have big bones but almost no one does. Then as two other doctors have done since, he got out his calipers to prove me wrong.
He measured several times and had to admit that in fact I had the largest bone structure, from wrist measurements, he had seen and at the very top of the chart. He palpated my wrists and found them very broad and without any flab at all.
Next, he brought out ye olde height/weight chart. As I recall his finding, at six feet even, I should weigh no more than 173 pounds, ideally five pounds less.
I went off and to the Stillman diet, used by two girlfriends. That meant almost no carbs and extremely low fat. I got weak and a few times nearly passed out, but I lost pounds. When I returned, I was around 175 or maybe a little under and feeling very accomplished.
He examined me, making odd noises. When he finished, I recall very clearly that he fairly exclaimed, “What the hell did you do to yourself!”
He said I was way too thin, my ribs were sticking out and that I did not have adequate fat on my torso. Having done what he commanded, I was none too pleased. He said I needed to gain at least 10 pounds back, slowly if I could.
Add some science
Since then, I listen politely when a doctor pulls out weight or BMI numbers. It’s important for them to play expert here, even when observation and listening to me should be more productive. With my own doc, I have said plainly that I use body-fat measurements and have no use for BMI. As muscular as I am, pure poundage or BMI is almost worthless.
Fortunately for this matter I grew up to be a relentless researcher when called for. That has worked well for me as a newspaper and magazine writer, and on occasion for such personal matters as diagnosing myself when medical types fail.
I would love to find a nutrition/exercise program with heuristics. I wish I had one as I assiduously tracked all food and liquid I consumed and all exercise I performed over several years. Then with the weekly entry of weight and body fat, I’d like that program to adjust the basal metabolism rate and perhaps rationalize the true exercise calories burned. I’d like to be able to trust the result so that at the end of each day if it says I lost .2 pound or whatever, it would be right.
Someone must be working on that. There are a lot of software applications that do learn.
Short of that, I researched to find out what I should be eating and perhaps why my metabolism doesn’t follow the estimates medical sorts use as gospel.
This series includes:
Call it Lifestyle on the intellectual and emotional commitment to low-carb
Watching the Struggle on my grandmothers diet woes
Wrestling with Fat on overcoming fear of dietary fats
Hunger? do you starve on a low-carb diet?
Low-Carb Eats on what’s on the menu in the regimen
How Much of What Food on calories-in/calories-out cliché
Dr. Cadaver on mindless trust in group averages
Who’s Counting on body fast v. weight
Part 1 on pants don’t lie