Why does my doctor want me to gain 15 - 20 pounds when my BMI is normal?
December 6, 2012 7:51 PM   Subscribe

Female, 32. 110 pounds, barely 5'3. Why does my doctor want me to gain 15 - 20 pounds when my BMI is normal?

I've been at this weight with tiny fluctuations for 6 months. This is a new GP. I've actually never had one before, the closest being my psychiatrist, whom I've seen at least 3 times a year for 7 years, and who has never commented on my weight, which has gone from a long-time standard 135 pounds to a post-pregnant 175 and over a year and a half down to 110. And I saw my psychiatrist last week. Data point: unconcerned psychiatrist is stick-thin. Concerned GP is by my eye-balling, moderately 'overweight' in BMI terms.

GP does not even know that my previous normal weight was 135. She does know that I lost 65 pounds post-pregnancy, but mostly intentional and maybe 5 - 10 pounds due to stress. Anyhow, who cares that I lost that much weight when it was over the course of such a long time?

I came to her with concerns about one cyst and two lumps (groin, armpit), which I am genuinely concerned about, but are likely nothing. I am a smoker. I've had bronchitis and have a bad cough. I am very visibly under extreme stress right now, probably come off to a doctor as anxious and depressed (mostly true), am not looking so great admittedly, and yes, am somewhat gaunt in the face, but that much of a weight gain? What would be the medical rationale if my BMI is 'normal'? I was in the middle of asking her why very meekly, but then my husband arrived and I was in shock and got sidetracked. She did say that BMI at lower weights in unreliable (I have no idea how true this is).

I would like to gain about 10 pounds so that I can look healthier. So, yes, for vanity reasons. Yes, I have some weight issues. Yes, gaining weight scares me a little. Yes, I am doing some depressive/anxious under-eating. But I don't understand a medical reason to gain any weight at all, much less 15-20 pounds. What is going on?
posted by kitcat to Health & Fitness (30 answers total)
Sorry for the grammar, spelling issues...very tired.
posted by kitcat at 7:53 PM on December 6, 2012

BMI is unreliable at any weight. By your own admission, you came across as anxious and depressed and gaunt (read: unhealthy) looking. You should talk to your doctor about this. You don't need to be meek about it -- you're supposed to ask those questions. Does your GP have email? Or will talk to you on the phone? Just ask!
posted by brainmouse at 7:57 PM on December 6, 2012 [4 favorites]

That may have just been her way of saying that you need to eat more/healthier, as you yourself have stated. But really, you need to call her or set up another appointment and ask.
posted by greta simone at 7:59 PM on December 6, 2012

[lost] ... maybe 5 - 10 pounds due to stress.

am somewhat gaunt in the face

I am doing some depressive/anxious under-eating

If so, it sounds like your GP is right?

If you look gaunt then yeah, that would be enough for any rational person to suggest you gain weight.

I agree that you should ask, but this doesn't sound ominous to me at all. My only thought is that she is slightly overstating the case or inflating her numbers to impart the reality of the situation, possibly thinking that if she says "you should gain five pounds", that won't lead to any change from you. My dad is a doctor and I hear him say things like that from time to time ("I told him X because if I told him Y I know that he would do Z"). It's a little manipulative, I agree, but not really a big deal.
posted by Sara C. at 8:03 PM on December 6, 2012 [17 favorites]

Food contains nutrition. Not eating is stressful to the body. Being hungry assists people in making bad decisions. Good fats and vitamins and minerals are important for a number of things, including bone maintenance, which is important in women. Cigarette smoking is not great for you in general but in particular in combination with all these things. And fat is a store of calories for hard times.

You and your doctor are in agreement that you should gain some weight! You're really over-thinking this. If you've stress-starved yourself to the point where you appear gaunt, something is going wrong, and it would be great for you if you would head that off at the pass before it festers into something worse.
posted by RJ Reynolds at 8:11 PM on December 6, 2012 [7 favorites]

Doctors tend to have pretty set ideas of what people "should" weigh. Sometimes that's not all that relevant to the person in question.

Do you feel like this is a healthy weight for you? Again, it's certainly very personal and you should do what feels right to you, but remember that many doctors get concerned about statistical risks for BMI groups--as a woman who smokes, for example, you're at greater risk of osteoporosis, and being under BMI=20 is also considered a risk factor for osteoporosis.

It is super hard to gain or lose weight intentionally, I know, so maybe you want to request that your doctor focus on specific health-related behaviors; weight itself is not a behavior.
posted by Sidhedevil at 8:25 PM on December 6, 2012 [2 favorites]

I would like to gain about 10 pounds so that I can look healthier. So, yes, for vanity reasons. Yes, I have some weight issues. Yes, gaining weight scares me a little. Yes, I am doing some depressive/anxious under-eating.

Great! Sounds like you and your doctor are in agreement!

But I don't understand a medical reason to gain any weight at all, much less 15-20 pounds. What is going on?


What's going on is you're in denial.
posted by incessant at 8:39 PM on December 6, 2012 [31 favorites]

Your doctor saying you need to gain 10 lbs is just one way of saying you need to eat more, which it sounds like you really do need to do, since you are doing some "depressive/anxious under-eating". Is it possible that she's concerned you may have an eating disorder? As someone who has had one in the past, I find some elements of your question point a bit in that direction, such as the comments about what your psychiatrist and doctor weigh (not at all relevant to this discussion) and obviously your comments about having weight issues and that gaining weight scares you a little (I wonder if it really scares you a lot).

I gently suggest that you try seeing a therapist for your anxiety and depression, since these seem to be issues of concern to you. Seeing a Psychiatrist three times a year is not really a stand-in for regular mental health care.
posted by imalaowai at 8:49 PM on December 6, 2012 [5 favorites]

The Wikipedia article on BMI is actually pretty good at explaining how it is useful as (and was created as) a tool for studying and analyzing populations, large groups of people, not individuals. Its increased use as a way to evaluate any given individual's health is highly controversial. It's entirely possible for any given individual to be outside the bounds of "normal" BMI (for a variety of reasons) and still be healthy.

So your BMI being "normal" is not necessarily the best gauge for determining your best weight.

You should definitely clue your new GP in to your past weight history, and the fact that you've been doing some depressive/anxious under-eating. Seconding Sidhedevil that you and your new GP should discuss a set of health-related behaviors, including your diet and eating patterns. Which should include an explanation of why and how your doctor would like to see you "gain weight" - I'm pretty sure your GP didn't just mean "eat ice cream until you're 20 pounds heavier."
posted by soundguy99 at 8:52 PM on December 6, 2012 [1 favorite]

Thank you for prompting me to read Wikipedia's BMI article. This is particularly helpful:

There are differing opinions on the threshold for being underweight in females; doctors quote anything from 18.5 to 20 as being the lowest weight, the most frequently stated being 19.

My BMI right now is 19.5.
posted by kitcat at 9:08 PM on December 6, 2012 [1 favorite]

At my absolute most healthiest, I was your exact current weight (and height). If some doctor had told me then (or now) that I needed to be 130 to be healthy I would laugh in their face and find a new doctor.

Quit smoking, don't lose anymore weight, and gain whatever you need to feel healthy. You're not emaciated.
posted by elizardbits at 9:08 PM on December 6, 2012 [4 favorites]

I know someone who is, like you, right at the very low end of "normal" BMI. You can pretty much tell by looking at her that she is underweight; she has very little muscle and looks frighteningly thin. Like you, she brushes off any suggestion that she is underweight by saying that her BMI is "normal."

What I'm saying is, BMI can be misused.
posted by medusa at 9:14 PM on December 6, 2012 [11 favorites]

BMI doesn't take body type, bone structure, muscle mass, or physical fitness into consideration.

People of the same height and weight can look vastly different from one another (and be at varying levels of health/fitness) due to the above factors.
posted by bearette at 9:22 PM on December 6, 2012 [13 favorites]

My doctor has told me a number of times that I should keep my weight above 126 pounds, as this is a cutoff for being at greater risk for osteoporosis (and it's not adjusted for height - the risk depends on having a certain body mass to store nutrients, not on your BMI).

So that could be a medical reason why the doctor is suggesting you gain 15-20 pounds, especially since smoking is another risk factor for osteoporosis.

You should talk to her, but honestly the depression and anxiety seem to be bigger issues than being slightly underweight, and you should probably focus on them first
posted by psycheslamp at 9:25 PM on December 6, 2012 [7 favorites]

I'm 5'8", and according to the BMI chart, a weight of 163 gets me just barely into upper end of the BMI's "normal weight" range, at BMI 24.9. To be at the lower end of "normal weight", I'd have to weigh 125 pounds. (Seriously, I would look skeletal at 125 pounds!)

I'm at 195 (BMI 29.6) now, and healthy, even though the BMI says I'm "borderline obese." A few years ago I was really sick and wound up in the hospital, and weighed in at 165 (BMI 25.1, "overweight") And every doctor I saw said "Oh my god, you are crazy underweight, we need to get some pounds on you like, yesterday."

Doctor says I should shoot for and maintain about 185-190 (BMI 28-29, still "borderline obese"), and stay active. Just had a physical, again 195lbs, BMI 24.9 ("borderline obese"), doctor says I'm perfectly healthy. Could stand to lose 5, maybe 10 pounds, but that's it.

I worry about how many people suffer depression or do harmful things to themselves because of this stupid BMI chart. :( Forget the BMI, it's total bullshit. It is simply a height-weight ratio, and takes absolutely nothing else into account. Not your build (I'm barrel-chested and built very stocky), not any other medical conditions, no family medical history, nothing. It's just a ratio of your height to your weight, and it is completely meaningless. Trust your doctor.
posted by xedrik at 9:35 PM on December 6, 2012 [8 favorites]

I don't think the numbers are telling the whole story here. Doctors don't tell otherwise health young people to gain weight very often, that would be fairly unusual these days. I'm guessing that while talking to you and doing your physical exam, it became apparent that you are underweight for your particular body.

The fact that even you think you need to gain 10 lbs, and the doctor says 15, and you're kind of obsessing about the 5 lb difference in opinions here and jumping on very specific notes about gradations of the BMI (a-ha! I'm 19.5, so that's normal in some people's books!) - these facts concern me about your relationship with eating and weight. I nth the suggestion to talk to your psychiatrist about this and do more frequent meetings for the time being.
posted by treehorn+bunny at 9:59 PM on December 6, 2012 [20 favorites]

Stating the obvious here, but maybe you should ask your doctor what her reason is?
posted by MexicanYenta at 10:32 PM on December 6, 2012 [1 favorite]

BMI is weird. I'm currently 5'4 and 128 and I need to lose a good 10 pounds to look my best. I don't look gaunt at that weight -- I look like a compact little person because of my build (although as I get older, my face looks better with more weight. The old "pick your face or your ass"), even though my BMI is about what yours is. But my Dad is borderline obese according to BMI but looks great, and would look TERRIBLE if he lost weight to get into the low BMI zone. Like, desperately ill terrible. So I would not put that might weight one the BMI, no pun intended. I would listen to your doc, rather than rando medical charts. You want to gain 10, she wants you to gain 15. Why not aim for 12 and see what happens?
posted by Countess Sandwich at 10:39 PM on December 6, 2012

Anyone here telling the OP that her weight is fine ("Because BMI I have the numbers the numbers tell me everything I shall ever and will ever need to know!") is acting irresponsibly and should repeat after me:

"Hey! Kitcat! The issue here is much much deeper than your weight. Please talk to your GP further. Please explore these issues with a therapist."
posted by incessant at 10:41 PM on December 6, 2012 [9 favorites]

Multiple studies have concluded the optimal BMI for longevity is 22-24 (for white women, up to 30 for black women), gaining 15-20lbs would put you in that range. But these are just tools. If you only want to gain 10lb, gain 10lbs and see how you look/feel. Even if you gain 20lbs that's still 5 less than your previous "normal" weight. Some people can look and be healthy at 19.5 but clearly you're not one of those people, I'm not either. I'm healthiest at around 24, at 19.5 I would be skeletal.
posted by missmagenta at 1:01 AM on December 7, 2012

You said you're scared to gain weight. That's the crux of the issue here. Your BMI is 19.5, which depending on who you ask is below normal, or on the very very low end of normal. Depending your build or even ethnicity, 19.5 could be very much so underweight.

Your perspective is skewed. Please get screened by a mental health professional for an eating disorder. You may not think you have one because you're not dying or skeletal and still menstruating but those are only some criteria. EDNOS-r(eating disorder not otherwise specified- restrictive subtype) is a very real, very dangerous problem. It may turn out you don't have those patterns, behaviors, signs, or symptoms on a clinical level, but it's critical that you let a professional make that decision.

The abyss is only a few steps away. You're not in the abyss. Don't fall in the abyss.
posted by lettuchi at 5:07 AM on December 7, 2012 [3 favorites]

Don't forget the actual, evolutionary, biological purpose of body fat (well, one of them). Unexpected loss of access to food doesn't happen so often or so severely in our society anymore, but circumstances can sometimes mimic that. I was at the high-normal range of BMI for my height earlier this year when I was diagnosed with a chronic illness. Since then, despite receiving top notch medical care, my BMI has dropped to borderline underweight. I'm very, very glad that I had that safety net of extra weight, because without it I would have ended up in an even more dangerous medical situation.
posted by telegraph at 5:32 AM on December 7, 2012 [1 favorite]

If you are under-eating and agree that you need to gain 10 pounds, why not start by gaining 10 pounds? Then, go back to your doctor and see what she says - does she still think you need to gain more weight, or does she think you are doing well at that weight?

And I agree that BMI is not that useful on an individual basis, especially at the tail ends. It is good as a rough guide, and great across populations. If it's helpful to hear examples, I stop getting my period (amenorrhea) due to being underweight around a BMI of 19; that is just too low for my body, no matter what "normal" is supposed to be.
posted by insectosaurus at 5:47 AM on December 7, 2012 [1 favorite]

You went to the doctor, the doctor suggested that you gain a bit of weight. You agree in theory that a little bit of weight gain would be a good idea, for looks if nothing else.

Don't think so hard about adding pounds, think about how to enjoy a more healthy diet.

If gaining weight causes you anxiety, if there's more to this than "I need to eat better" in your mind (which is really all anyone is saying) and if you believe that you would benefit from visiting with a therapist regularly, then you should do so.

I did some great therapy with a counselor who specializes in eating disorders, and really learned some helpful strategies for understanding what normal eating is. (I didn't know that eating a 'movie' sized box of Good n' Plenty was a binge. Now I do.)

Couldn't hurt.
posted by Ruthless Bunny at 6:02 AM on December 7, 2012 [1 favorite]

But I don't understand a medical reason to gain any weight at all, much less 15-20 pounds. What is going on?

Here is what's going on:

[lost] ... maybe 5 - 10 pounds due to stress... am somewhat gaunt in the face... I am doing some depressive/anxious under-eating
posted by spaltavian at 9:15 AM on December 7, 2012 [1 favorite]

Just want to throw out one thing -- you say you're postpartum, but didn't say anything about breastfeeding. On the off chance that you have done or are doing some of that, keeping up your food intake becomes particularly critical, as providing all that nutrition to somebody else can drain your own stores, especially of important minerals. So there's that too.

Good luck getting to a stable feeling place, both emotionally and physically!
posted by acm at 9:26 AM on December 7, 2012

What telegraph said. Most people have a 10-15 pound range from "barely a hair skinny" to "barely a hair puffy" (and a much larger range from underweight to overweight). If your typical reaction to stress is to lose weight, then staying towards the top end of that buffer is a pretty good idea.
posted by anaelith at 9:55 AM on December 7, 2012

Gaining weight is not the task your doctor has set for you. Gaining weight is the *result* of the task, which is eating more regular meals and reducing stress. Think of it that way ("yay, food!" rather than "oh no, weight gain!") and maybe it will be less weird. Take care of yourself, eat right, get some sleep, and weight gain will most likely follow naturally.
posted by chaiminda at 12:05 PM on December 7, 2012

Wow, these answers have been really helpful, in pointing out that according to some metrics and BMI interpretations, I really am underweight or close to it, and that there are some serious health reasons one should not be underweight or close to it. And the point about being on a slippery slope to an eating disorder was well-made. I think my doctor is exaggerating the amount I should gain, but perhaps intentionally and strategically (who knew doctors did such things?), knowing that I won't really gain quite that much. I will be more trustful of my doctor. And eat heartily as my stressor disappears and holidays ensue. Thank you.
posted by kitcat at 8:09 PM on December 7, 2012 [1 favorite]

I was thinking about your question again, and it strikes me that your pregnancy plays an important role in this. The physical changes of pregnancy are huge. The rapid changes in one's body plus weight gain and weight loss plus hormones are all a lot to deal with. It messes with your mind, your body, and your body image. I'm currently losing the weight from my pregnancy and while I'm mostly feeling good about my slow steady weight loss, there are moments when I freak out about how far I have to go and I think, who cares about being healthy? I just want to be skinny.

I also find that after having so little control over what happened to my body during pregnancy and just after birth that the desire to "get my body back" and have control over my body is really strong. At the same time, I realize that the desire for control - and specifically wanting to control my body/weight when so much of the rest of my life is less under my control because of the baby - that desire is taking me down the path of eating-disorder-type thinking. So it's great that you're thinking about this and asking this question, and you might want to talk to your psychiatrist or a therapist about how the physical change/weight change rollercoaster of pregnancy may be affecting how you feel about your body.
posted by medusa at 11:11 AM on December 8, 2012 [1 favorite]

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