“Too Fat to Graduate”?


As far as sensationalist headlines are concerned, this one ranks pretty high. But it’s not altogether an inappropriate one to use in describing this story, although I do find it a little ironic that I chose to write about this after Thanksgiving holidays — a time specifically set aside for gastronomic excess.

This morning, CNN’s website featured a story on Lincoln University, a historically black college that has instituted a different take on the physical fitness requirements many schools implement for their undergraduates. Like many private and public institutions, Lincoln requires their undergraduates to meet a certain physical fitness requirement in order to graduate. However, unlike other schools, Lincoln is basing their distinction between “fit” and “unfit” students on body mass index (BMI), and are requiring students who have a BMI greater than 30 to take a special physical fitness class, called “Fitness for Life” that meets three times a week and includes aerobic exercises like water aerobics and Tae Bo.

For those of you who are unaware, BMI is an index used by health professionals to determine one’s general health. It is calculated by entering one’s weight and one’s height into a formula that generates a score can then be compared against what a healthy person’s “expected” score should be. Heavier people would, of course, have a higher BMI than lighter people of the same height. The BMI score can then be categorized against indicators of health:

BMI Categories:

  • Underweight = <18.5
  • Normal weight = 18.5-24.9
  • Overweight = 25-29.9
  • Obesity = BMI of 30 or greater

As a researcher in the biomedical sciences, I can tell you that BMI remains a basic tool in the toolbox of physical trainers and body composition phyisiologists, primarily because BMI is so simple to use. Compared to more accurate measures of determining a person’s body composition (i.e. how much of their body is muscle, fat, etc.), BMI requires only a tape measure and a scale, making it one of the easiest numbers to calculate in the field. In fact, BMI is so straightforward to calculate that free BMI calculators abound on the Internet — here’s one that I regularly use to monitor my own BMI.

But, here’s the dirty truth about BMI that health professionals are loath to reveal: it just isn’t a very good measure for determining a person’s health.

It turns out that the label “healthy” has nothing to do with appearance and weight; rather, it has everything to do with cardiovascular health. Folks with a lot of fat tend to carry it in their midsections (abdominal if it’s under their skin around their bellies, visceral if it’s built up around their internal organs), and this fat is directly linked with increased health risks, such as hypertension, atherosclerosis and heart disease. That’s because more fat in your belly area means that you have more fat built around your internal organs, making them work less efficiently. In addition, more fat around your belly indicates you’ve got more fat throughout your body, including fat built up on the inside of your blood vessels reducing their diameters (like a drain slowly clogging with hair), making it more difficult for your heart to pump blood through them.

And really, therein lies the rub: it’s not that the fat is directly making a person unhealthy. In fact, both men and women need a fair amount of fat in their bodies to maintain health — indeed, for women, more than 20% of their bodies need to should be made up of fat to avoid problems with menstruation. Instead, what makes an overweight person unhealthy is the amount of work their heart has to do to keep pumping blood through their bodies, particularly as vessels get blocked with fat deposits. Eventually, their heart becomes too weak to generate the extra force to keep blood pumping away, and it fails.

In other words, folks with high BMIs need to reduce their body fat and strengthen their hearts, in order to stave off the progressive risks of cardiovascular disease. But notice, I didn’tsay that folks with high BMIs need to lose X number of pounds or hit a target weight (or BMI). A person’s weight is a convenient measure of fat, but it relies on an assumption that people have a generally constant (or predictable) amount of weight that is due to muscle or bone — which is untrue — such that any increases in BMI are due to excessive weight from excessive fat.

As all of us know intuitively, some people have large (heavier) bones, and some people have small (lighter) bones. Some people have lots of muscle, and some have very little muscle. BMI assumes a generic percentage of each person’s weight is due to bones and muscles, but it’s quite easy to fool BMI by having non-average bone structure or muscle. Even moderate athletes who do strength training will have more than the typical person’s muscle. Since muscle weighs more than fat, athletes tend to weigh more than non-athletes, and since BMI is blind to what kind of tissues make up a person’s weight, it will classify an athlete as having a higher BMI as a non-athlete of the same height. In fact, a superior athlete like Arnold Schwarzenagger, in his heyday, would have been considered obese (or even morbidly obese) according to the BMI scale. Moreover, a person’s appearance has as much to do with one’s genetics (and age) as anything else; even people with good cardiovascular performance may appear pear-shaped or even have some abdominal fat; the fat alone doesn’t make them unhealthy.

Which is why many of us in the scientific community use BMI with a grain of salt. BMI data are so easy to collect that patients can be sent home with a scale and can be taught to collect the necessary numbers on their own. But BMI is an imperfect measure of health; what we really should be looking at are measures like body fat percentage, which directly measures how much of a person’s body is composed of fat (versus muscle and bone), allowing us to accurately determine a person’s risk factors for disease. Or for that matter, we should measure performance on aerobic tests (such as running or swimming) to determine one’s health. 

Unfortunately, our society’s close reliance on BMI has helped encouraged a weight-conscious culture that associates weight (and therefore appearance) with health, producing an unhealthy (pardon the pun) obsession with losing weight without actually promoting cardiovascular health. Weight loss pills fill the aisles of pharmacies, and gastric bypass surgery and liposuction is abused by dilettantes looking to squeeze themselves into the latest Vera Wang fashion. Even shows like “The Biggest Loser” celebrate shedding pounds, but spends comparatively little time teaching contestants about reducing heart rate, blood pressure, or cholesterol — the true culprits for a larger person’s poor health prognosis.

Which all leads me to the article that prompted this blog post. Lincoln University wants to enroll students with a BMI greater than 30 into fitness classes. These classes will probably promote education on healthier living, but are also an institutionalized fat camp, designed to put students through an aerobic workout designed to help them shed pounds. On the one hand, I believe it is important for students to receive an education on physical fitness in college (and even in high school), and a class that teaches students about exercise and nutrition will help those who need a “wake-up call” about their health and encourage them to for their own fitness. With the obesity epidemic the way it is in America, twenty-something students need to know the grim prognosis if they can’t walk a flight of stairs without being out of breath.

That being said, I think it is completely unjust for Lincoln University to target students with high BMI’s for this fitness class. Even though school administrators have taken steps to address the imperfect measure of the BMI (by taking waist circumference, which will be lower in athletes with high BMIs due to increased muscle mass), the current system of targeting students with high BMIs is just a grown-up version of the same schoolyard antics: let’s all point and laugh at the fat kid. As a society, we’re titillated by the mental image of fat people doing aerobic activity — how else do we explain the popularity of shows like “Celebrity Fit Club”? Mandating that “fat” students take fitness classes is just another way of telling overweight people that they are different, lazy, unworthy, ignorant or stupid, and altogether deserving of our finger-pointing. As a society, we blame the overweight person for being overweight, and in so doing we lose sight of the definition of “healthy”.

We assume that people of “normal” weights don’t need this kind of aerobic training, yet how many of your “normal weight” friends can run a 5K in under 30 minutes? How many eat the proper balance of protein, fat and carbohydrates each day? How many have a systolic blood pressure below 120 and a heart rate below 90? How many of your “normal weight” friends smoke, drink, and engage in other risky behaviours that could compromise their current and future health? How many of your “normal weight” friends lack sufficient upper body strength to perform 20 push-ups?

The bottom line is that all of us have something we can learn from a “Fitness for Life” class, and if Lincoln University wants to promote health in their student body, they should require all students to perform to a certain standard in a physical fitness test, regardless of BMI. If students can’t demonstrate sufficient fitness, then they should be enrolled in the “Fitness for Life” class, again, regardless of BMI. If, as the school states, this new mandated class is intended to promote physical activity in our nation’s youth, than that opportunity should be extended to all students based on their fitness (or lack thereof) — not based on an imperfect, sloppy measurement of health that even health professionals should eschew.

And why does this story hit so close to home? Well, those of you who have followed this blog for some time probably know that I have struggled with my weight for my entire life. Being Asian made it all the worse; all of my APIA female friends were stick figure thin, while I felt alien in my curvaceous skin. The message couldn’t have been plainer: growing up, I simply knew that there was something fundamentally wrong with me. As a child, I was encouraged by my parents to be academic; consequently, I grew up with virtually no emphasis on productive physical activity. I didn’t play a sport, and only through my high school’s physical fitness requirement did I learn how to do distance running. And although I was teased my whole life for being large (or endomorphic, or Reubenesque, or any of those other euphemisms used to try to soften the blow of being called “fat”), I didn’t know how to make the lifestyle changes I needed. For the first 25 years of my life, I concentrated on trying to tip the needle of my bathroom scale and only ended up running myself in circles. I don’t even want to recount the dark thoughts I had at the bleakest points during my struggle with my weight.

This past January, I found myself at my heaviest and in the worst shape of my life. My turning point was when I needed to walk up a small incline near work to go to a local get-together. The incline, barely more than thirty feet in elevation, caused me to be out of breath. I was only 26 years old. 

From January onward, I decided to make a change in my life, and one that would stick this time. Rather than to focus on pounds, I have educated myself (with the help of an incredible physical trainer friend of mine) on cardiovascular fitness and appropriate nutrition, and I have prioritized physical activity in my life. I learned about heart rate and blood pressure, about the benefits of different kinds of aerobic training, and even started to lift free weights to improve my muscle mass. And yes, now that I have been on a schedule that involves nearly daily cardiovascular activity and strength training, I have lost more than 40 pounds. But, more importantly, I have raised my systolic blood pressure (I was hypotensive and prone to dizzy spells indicating a weakened heart), reduced my resting heart rate by nearly 30 beats per minute (the lower the better), and corrected an anemia that prevented me from donating blood (I am once again a regular blood donor).

And as for that little hill that caused me to start on my physical fitness journey? Let’s just say that last month, I climbed the tallest mountain in Southern Arizona.

That’s not to say that I’m done — far, from it. The biggest change in my life is that I now look forward to the physical activity that I have incorporated into my daily schedule. I am motivated by fitness goals, and I celebrate my fitness milestones however private they may be. For the first time in my life, I am within “normal” (or athletic) ranges for weight, body fat percentage, hip-to-waist ratio, and heart rate, and I finally feel in control of my own health.

Yet, I am still a curvy girl, and I probably always will be. But I bet you this: I could probably run rings around several of the extra-skinny girls who go to my gym, many of whom are so fixated on the “thin is in” mentality that they can’t maintain a two-minute sprint on the treadmill and refuse to perform any strength training with anything heavier than a 2lb-weight. Those girls might be thin, but they haven’t spent much time improving their health.

Which leads me to the biggest lesson I learned this year as I got into shape: no amount of name-calling, finger-pointing, or social mockery will help an obese person get into shape. In fact, the last thing an overweight person needs is ostracization; you simply cannot shame a person into getting fit. Frequently, overweight people are saddened, embarassed, or frustrated by the health risks associated with their obesity. They aren’t overweight because they don’t care about their health or their appearance — they are overweight because they don’t know what they can (or should) do to fix it. Meanwhile, those who indulge in name-calling and giddy pleasure over insulting the “fat” people amongst us do so out of insecurity — because every person suffering from low-self-esteem feels better if they can make another person feel even lower.

If we’re going to overcome the obesity epidemic in America, we need to divorce health concerns from superficial appearance, and focus on educating America — all of America — on what they can do to get (and stay) healthy. We should make everyone want to get in better shape by supporting, not berating, those who aren’t. But, we must also remember that overweight people must choose to make a change in their lives. That choice cannot be made for them, neither by Lincoln University administrators nor by overgrown schoolyard bullies.

But I do guarantee this — if you’re contemplating making that change, take it from me: it was the best choice I ever made for myself.

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