Updated: Dec 1, 2021
Nature Knows is a three part series exploring the natural tendencies of animals, and how to use these tendencies to better understand ourselves.
A whippet and a Saint Bernard do not look alike. But, see either on the street and I’m going to run up and ask to pet them regardless of their appearance! Each animal was bread for a different, but vital, role. The Saint Bernard was bred to stay warm and travel long distances to rescue lost travelers from the cold Switzerland winters. The German Shepherd was bred to be an alert guard and sprint after any invaders.
But there are so many breeds, and mixes of these breeds, it’s hard to have any recommendations for each type of dog.
In the medical field, we like to know that the advice we’re giving is perfect.
Which makes sense, medical professionals are humans too, and we like the comfort of knowing we did the best, especially when lives are at stake. However, health isn’t black and white. People have all different backgrounds, and everyone is a mix of something from way way back. It’s hard to identify what we should or should not be like.
The Body Mass Index was created to simplify decision making of who might be healthy and who might be unhealthy. Which in and of itself is a problem, as health isn’t determined by weight or size. In the 1830’s, we didn’t have sophisticated ways to tell if someone was at risk of disease- such as blood tests, ultrasounds, urinalysis, genetic testing, etc. We didn’t know that most diseases are manageable or even curable. So, a statistician came up with the BMI equation to attempt to categorize and simplify healthcare. Pop your weight and height into an equation and- Boom! There’s your health risks!
Except...it’s not that simple. Genetics, stress, and environment play and equal role in our health. But there’s no standardized equation to measure your stress. Imagine if we put equal importance on our stress as we do our weight:
“Your stress is over the 99th%ile! I’m prescribing you puppies- stat!!!”
I welcome you to take a moment to unwind with some photos of my new baby boy, Banjo.
Even though stress has been shown to be a major determinant of health, the majority of health professionals are not concerned with stress, or any risk factors other than weight.
Unfortunately, as time went on and doctors became busier and busier, we began using the BMI equation as justification to prescribe changing one’s body as health. Doctors no longer had time to hear about a patient’s history, look at lab values over time, or recommend reasonable goals.
A veterinarian would never expect a Saint Bernard to look like a German Shepherd.
Why do (some) medical professionals see a kid who’s been growing along the same curve his whole life, and tell him to lose weight? Why is his larger body “wrong”, but his starved and obsessed-over body “right”?
It’s easy to internalize shame when being told to lose weight. When you think about the complex history of BMI how ingrained it is in our healthcare system, it’s easier to let that shame be the doctor’s and not your own.
As I was writing this, a colleague brought to my attention that my metaphor is very similar to Poodle Science. How I had never heard of this amazing video, I don't know!