Fitness, Fatness, and Aesthetic Judgments of the Female Body: What the AMA Decision to Medicalize Obesity means for other Non–Normal Female Bodies

“I’ll be happy to refer you to our dietician to get you on a program to help you get your weight under control before it becomes a problem”.

As my new physician spun around out of the examination room door, my head spun faster. I had heard the phrase “get your weight under control” twice that morning, but the contexts in which the phrase was uttered could not have been more different.

At 7:30 a.m., my fitness trainer was imploring me to get my weights under control as I struggled under a bar, laden with slightly less than my body weight, to do a final set of front squats. At 11:15 a.m., my new general practitioner was imploring me to get my weight under control, by which he meant to learn how to reduce my body mass index (BMI) to match the chart prominently displayed on his office wall. The exhortation to get my weight under control meant such radically different things in these two contexts that it was difficult to comprehend the meaning of the phrase.

I am 5’4” and 158 pounds. This gives me a BMI of 27.3, which means that I am considered overweight; right in the middle of the category of overweight. Or, according to the definition of the BMI found on the calculator pinned to the National Heart Lung and Blood Institutes (NHLBI) webpage, I am over fat. If the BMI is, “a measure of body fat based on height and weight that applies to adult men and women” then I carry a health–threatening percentage of body fat. If my fitness trainer, with his 12 point skin–fold caliper test is correct, my body fat percentage of 17% is within the limits expected of female (non–endurance) athletes. In terms of health, then, I am a paradox: according to one standard, I am healthy and fit, according to another, I am unhealthy and fat.

As this new physician picked apart my weight, suggesting I should lose between 15 and 20 pounds to bring myself to “full health”, I found myself quite annoyed. He was a small, rail thin, man with greying hair, tired eyes, unpressed khakis, and a beaten pair of black–ish grey “Crocs” on his feet. He looked disheveled and as if he had not seen the inside of a weights room in his life. As I listened to him address my history, current vitals, and how being overweight in my 30s could lead to being “fat and 40”, I looked him over and made a snap judgment of “I could bench (press) you [right out this window]”. While I was angry with his delivery, I tried to remind myself that he was an overworked physician in a multi–lingual office, trying to operate under a new paradigm in healthcare policy, practice, and diagnostic categories. Specifically, prompted by the medicalization of the condition of obesity by the American Medical Association, my physician was reflecting the professional wisdom that I suffer from a condition needing preventive treatment. He was trying to be a good practitioner to recommend preventive treatment, but to me, he was being a terrible physician.

The AMA Declares Obesity a Disease

The declaration by the American Medical Association in 2013 that the condition of being obese is one that requires medical treatment is one that I, on the face of it, support. By inviting the medicalization of the condition, the AMA opens the door for individuals who wage a deeply personal battle with their weight to find support in their physicians’ offices and from their insurance companies. Yet, the blunt tools that are used to assess these conditions raise my ire, emotionally and intellectually.

Intellectually, the use of the BMI calculator for snap diagnosis of all individuals makes easy sense. It is an easily comprehended tool and, for a normally distributed population, such a simple tool is an excellent choice. But, it stands to treat outliers like me poorly. Outliers, such as particularly fit...