|Except I didn't exactly get an A+....|
For the past 52 years, the NHANES has been conducted yearly by the national Centers for Disease Control and Prevention (CDC). It's the nation's most comprehensive study on the health and nutritional status of Americans. I've run across numerous academic articles citing NHANES data in my own research, so the opportunity to actually be a data point for this study was totally intriguing to me! When we were asked be interviewed in our home, and then to come to the study site to participate in numerous medical tests, I didn't hesitate for a second. Michael acquiesced, even though it wasn't his idea of a fun Sunday afternoon. In addition to the pure coolness of the experience, we received a lot of (free) medical tests, and were paid a few hundred dollars for our time and participation.
|One of the CDC NHANES health study trailers!|
|Michael at the NHANES site.|
The short story here is that I was given an outsandingly clean bill of health for every item, except for my "Body Measurements" (i.e., my BMI and waist circumference). You can check out full the report in the images I'm including in this post. (Screw anonymity!) My "Blood Pressure & Heart Rate" are "within the normal range", my "Oral Health" was deemed adequate, my "Hearing" was also normal, my "Muscle Strength" was excellent (!) and all of the measures taken in my "Complete Blood Count" were within the normal range.
But, at 159.8 pounds at 5 ft. 5 inches, my Body Mass Index (BMI) is 26.5, so I am considered "overweight" by our current medical standards (though I would have been considered "normal weight" just a few years ago!). Add to this the fact that my waist circumference of 36 inches is 1 inch above the recommended maximum, and suddenly I've been warned about "an increased risk of health problems such as type 2 diabetes, high blood pressure, and cardiovascular disease."
Okay, so those are the "facts" of the story. Here are the feelings: it completely sucked.
I've embarked on a serious (and very public) self-acceptance project in which I haven't seen myself in the mirror in months, and I conquered an eating disorder almost a decade ago. Add to this the fact that I KNOW that I'm at a healthy weight for my body, and - here's the kicker - I'm intimately familiar with research published by the CDC (yes, the same CDC running this study!) illustrating that the "overweight" BMI category actually has the LOWEST mortality rates (yes, that means lower than the so called "normal" BMI category). In fact, my current BMI of 26.5 is basically at the "sweet spot" for low mortality rates, according to this CDC study, and many others.
I've read these studies, and know the data. I've been a co-author on research examining bias in news-reporting on overweight and eating disorders (Click here to read my favorite!). Oh, and according to NHANES, my every other health measurement was rated either "normal" or "excellent". In other words, knowing all of this stuff, I should have been in a pretty good position to not care much about the health report card I received from NHANES.
|My official "Preliminary Report (Card) of Findings"|
So what happened? I read the report and "felt fat". (Yes, I know that "fat is not a feeling" but ya'll know what I'm talking about!) Suddenly my "normal" blood pressure (yay!) was replaced by a warning that my 36-inch waist was putting me at risk for "high" blood pressure (ugh!), and my "excellent" grip strength didn't feel so excellent anymore. Despite the above data, my personal history, and my current commitment to self-acceptance - especially my belief in Health at Every Size - I struggled for several days to banish the urge to go on a crash diet. (Do you remember my Day 241 Mantra Monday post in which I wrote about needing to have "Trust, Faith, and Patience" for my body? That was the day after I participated in this NHANES study.)
So am I really peeved at NHANES? Well, not extremely peeved, but concerned. I've had two weeks to put this all in perspective, and that's what I've tried to do. I've considered my panicked reaction to "learning" something about myself that I actually already knew. Did a part of me (the anorexic part) actually LIKE being told I should lose weight? I think that's part of what shook me. NHANES didn't know I used to be anorexic and that their "report card" could, therefore, be triggering. Also, there are clear instructions on the Report of Findings, that "interpretation of these measurements must be made by a physician". For the record, my physician is totally cool with my BMI. (I haven't had the chance to discuss this waist measurement issue with her, but hopefully she'll just tell me to stay active, wear some spanx, and get on with my life!)
Yet, now that I'm feeling more "normal" (aka, empowered and outspoken) I can honestly say that the NHANES study seems to be biased toward preventing weight gain, as opposed to preventing eating disorders. My first clue didn't come on my "Preliminary Report of Findings" but in the wording of one of the interview questions asked during our home visit. The field interviewer asked me if I'd "ever participated in any weight-loss diets". My answer was "yes." Then she asked me, "How much weight did you lose in your most successful weight-loss attempt?" The NHANES computer program only allowed her to record the (horrifying and unhealthy) amount of weight that I'd lost in my most "successful" attempt, but there was no space to specify that "it was due to anorexia and she could have died." Upon my urging, she added a special note, but I have no idea how this will be handled when the data are analyzed. This is troubling: the wording of this question frames any weight loss as good, which we know isn't true. Another thing I noticed: despite asking me to describe, in detail, every bite of food that I'd eaten in the prior 24 hours, I was never asked whether I'd purged any of this food, or if I had taken laxatives or diuretics (I hadn't, but that's not the point). Through these questions (and non-questions), some of the most dangerous health behaviors - such as crash-dieting, purging, laxative abuse, and extreme food restriction - are made invisible.
I know this post is getting long, so I'll end with this: participating in NHANES was interesting and cool, yet eye-opening and concerning. For me, it triggered some (eating) disordered thinking. Further, both the wording of some questions, and the absence of other questions, cause me to question whether our nation's most comprehensive health and nutrition survey is concerned with the presence of eating disorders at all. Finally, if the data gathered from the NHANES studies actually show that my BMI is in the category with the lowest mortality, why did NHANES send me home with a report card describing me as "above the range of a healthy weight"?
But what do YOU think? Am I biased for having these concerns?? Have any of you ever had a physician or other medical entity make assumptions about your health without asking the right questions??
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