Body Mass Index and "Obesity"

[Tetragrammaton]

I need your personal and / or professional opinions and advice about a recent incident that continues to bother me.

Sometime late March 09 following sessions of lead up training for the annual Battle Fitness Test (BFT), I had been experiencing significant pain in the exterior of my right foot, shin and calf, to the point I actually went in to the Medical clinic to see if anything was wrong. I'm usually the type to avoid medical treatment and medications whenever possible.

The MCpl Med Tech on duty that particular day at sick parade asked me a series of questions and then weighed me. Now, I'm the first one to admit that (at the time) at 5'5" (166 cm) in height and  207 lbs. (94 kg) and with a waist of 38 in. (97 cm) that I was well beyond my comfortable body weight. Generally, over the last few years, I feel and perform best when in the 175 to 180 lbs. range. I'm stocky and carry a lot of weight in my legs and have been heavy for my stature since adolescence. The Med Tech, who she herself is about 5'10" and may be 130 lbs., built like a distance runner, had only one topic for discussion; the fact that given my height and weight, I had a Body Mass Index of over 32 and, as such, I was obese.

At the time, it pissed me off as it was just about the last thing I wanted to hear as I was experiencing pain from a mandated physical training activity. Again, it didn't come as a surprise that my weight was an issue, but I did take objection to it being pointed at as the sole and only source of my problem at the time. Regardless, I was later prescribed anti-inflammatory medication and told to take it easy for a couple of weeks. I continued to march gradually increasing load and distance as the date of the BFT approached. In May 09, struggling somewhat during the actual BFT, at about the 11km completed point, I felt a slight pop in my right foot. It was the sensation much like stepping on an egg on the road. Looking back I could not find anything and not experiencing any significant "new" pain, I continued and completed the full 13 km with a time of 2h21. However, following a short rest period of about 5 minutes, I was then unable to complete the casual extraction portion of the BFT as I was unable to support any weight on the foot. The following day, considerable swelling and inability to support weight on the foot brought me back to the clinic where it was quickly determined that I had a complete stress fracture of the fourth metatarsal bone in the right foot, mostly likely caused during training for and the actual BFT march.

So, my questions are the following;

1. Should I have taken it personally in regards to how the MCpl Med Tech dealt with me during that initial visit at the Medical Inspection Room? She wasn't incorrect in her point that my BMI is way too high. Generally, I personally do not lend much credence to the BMI index. According to it, my ideal body weight should be between 111 lbs to 150 lbs. I have not been 150 lbs since about the age of 16 and I would not want to even imagine what I would be like at the lower end of the range.

2. Should I speak to her about it now?

 

[Tetragrammaton]

Just a quick follow-up, I've been working to reduce my overall weight in fat and improve my cardiovascular endurance.

I'm at about 197 lbs and would like to get that down to about 175 lbs, BUT the actual weight is less important to me than physical performance.

 

[ballz]

I'm no professional obviously but it's been pretty undisputed for a while now that BMI is rather inaccurate and should only be used to cause a further investigation.

I happen to have gotten a full body composition done recently by probably the most accurate measuring devices available (a DEXA machine, for Dual energy X-ray absorptiometry) at the hospital (it was for a study that I participated in on genes and obesity, of course, the only reason I participated was to get the results of these tests ;D).

Now, my BMI at the time was 27.3 ("Overweight," just as close to "Obese" as I am "Healthy"). My Body Fat %, which is a better method to go by, says that I am quite healthy, and so did all my other tests (chlosterol, blood pressure, resting heart rate, etc) So why the discrepancy? 

My bone density is nearly 2 standard deviations above the mean, something that BMI can't take into account and never could have explained. In fact, if I were in the healthy BMI zone, I may just be severly underweight...

So, I guess all I'm trying to say is that if you are concerned, see your medical staff and ask for a further investigation. But don't go crazy over your BMI, even though it may ring some alarm bells for a further investigation.

Just my unprofessional 2 cents.

 

[Ascendant]

The BMI is a massive failure.

I'd just let it slide, no use in working yourself up over it.

 

[Tetragrammaton]

I've had trouble letting things slide in the past.

I just don't want what I suspect is a personal mindset in this member blurring the lines of medical and physical fitness. I really don't want this to become her approach with any future patients who do not measure up in terms of fitness.

Never has my being overweight kept me from completing any tasks or training. I may not have always been in the front of the pack, but I've always gotten there... eventually.  ;D

 

[Task]

1) Should you take offence? Nope not even a little. It's unfortunate she did not elaborate on other methods of measure, but as you said she was correct for the BMI.

2) I would let it drop. On the other hand if it still bothers you then yup tell her so.


Here is the problem though... You were insulted because she said that you being overweight was the cause.
For the first time because of it <and your ruck> you were not able to: "Never has my being overweight kept me from completing any tasks or training." 

So consider NOT venting your frustration on the tech that said you were overweight, because in the end she is was still correct.


  "blurring the lines of medical and physical fitness" is already blurred for me.  I see physical fitness as being part of medical fitness.

 

[McD]

Hey there,

First off, bad news over your foot. Sorry that happened.

From what you said of the experience, my non professional opinion (since I have yet to fully complete my EMT, and even then I will be no Doctor haha) maybe she was indicating you had a stress injury. From just the symptoms you listed, and being cognisant of which topic I clicked on, I immediately thought stress injury due to weight. I won't try and fill the place of a Med Tech or Doctor in saying that, it's just what I thought of.

Why did I think of it? It's an extremely common injury and the more weight you have on you the more susceptible you are. Let alone under a weighted pack. So should you feel offended? No it can happen to anyone.

Obviously since I wasn't there maybe she was addressing the weight and the physical activity you were doing as contributing factors to your symptoms of what are extremely common of stress injuries. You could argue she didn't pay enough attention to the injury complaint but often the complaint is a result of other factors.

Would any competent person worry about treating a sore shoulder and arm if someone who was ashen in complexion, over weight, middle aged and had just climbed a flight of stairs ?  (I am trying to paint the picture of a very obvious heart attack- not in anyway likening you to this made up character) No they wouldn't worry about their arm, but what the contributing factor behind the symptoms? I'd hope so.

I'm 5'11" and given the day 190 to 200 but used to be 235 to 250 in college doing heavy weight training. When I started switching work out regimes from power lifting to a core athletic performance and endurance based strength training program I encountered these effects of excess  weight on regular ol joints.

Good luck with a speedy recovery ! Sounds like you're well on your way to a more comfortable mind set anyway.   

 

[Armymedic]

I'll say it.

First, if you had a problem with it, you should have brought it up at the time, not a year later.
Second, she was correct to bring it up, as injury and cause (as it seems to me by your story) were apparent.
Third, you know she was right, because you have since attempted to correct the issue that caused your injury, and lost weight.

Finally, as a soon to be WO physician assistant, if you would have brought this issue to me, based upon what I read here, I would have echo'ed the MCpl,  albeit with perhaps a better explanation, and pointed out that your BMI was one contributing factor in your injury, AND as a over 40 year old person, having a BMI of over 30 and a waist size of over 36 does put you at a higher risk of an early heart attack.

So you would be in error to even mention this again.

 

[Tetragrammaton]

Thanks for the advice one and all.

I've since accepted the fact that my obesity contributed to the injury, even if it was not the root cause.

I'll continue to work on getting the weight down.

As far as mentioning something to the Med Tech... I will only do so should I ever have the opportunity to speak with her during the next forced march and only as I pass her.  ;D