- Dr. Jenna Daku
Why I cancelled my 'Health MOT": Challenging the stigma around health, exercise and weight
I have a gym membership because I enjoy moving my body and I don't always enjoy moving it outside - especially when it's cold and raining. I signed up for this particular gym because it offers me a wide variety of options for moving my body: a pool, a multitude of classes, a decent weights area and various cardio machines. The only thing I don't really like about my gym is the dent it leaves on my bank account every month, but that's to be expected given where I live in London.
When I signed up for my gym, I was paired with a personal trainer who did something called a "Health MOT". This was an hour long session with a guy I'd never met before who measured my blood pressure, blood sugar, resting heart rate and calculating my BMI by using my height, waist size, and weight. He then watched me do a series of exercises to determine my core and cardiovascular strength. Afterwards, he told me all the ways that I could improve my 'health' through food and exercise. The emphasis here was on how I could lose weight in specific areas of my body in order to improve my health. While this was all well intending, I admittedly left feeling a little crappy, but I brushed it off and continued on with my busy life without giving it all much consideration. After all, I've got plenty of experience critiquing my body and as a woman I've been conditioned to want to change it.
Fast forward a year to earlier this week when I walked in to the gym and was reminded that it's time for my yearly 'Health MOT' to "track my progress". I wasn't particularly thrilled with the idea, maybe that's because I hadn't actually been doing all of the things that the personal trainer had recommended for the simple reason that I didn't really feel like changing my body and I'd actually been feeling pretty good about it. But the girl at the front desk just seemed so excited to offer me a free 'health' check up that I found it difficult to tell her that I wasn't really interested. So, I booked it and went off to my gym class without thinking much about it. Now, I'll be the first to admit that this is a boundary that I'm going to have to work on for myself...because the more I thought about my upcoming 'Health MOT' the more anxious and angry I felt. So, I switched tactics and decided that I would sit with these feelings and see what emerged. This led me to reflect further and do a bit of research, and here's a very brief overview of what I discovered:
Firstly, I'm not originally from the UK and so I don't actually know what MOT stands for. Google kindly informed me that it is an acronym for a full body medical scan or exam and that it's derived from the Ministry of Transport. Naturally this caused me to put on my feminist hat and I thought to myself: So, what, my body is just a vehicle that needs to be examined and fine tuned yearly by some random dude at the gym? As if my body isn't objectified enough as a woman...it's no wonder I left feeling crappy.
Also, I don't recall being asked any questions about my mental, emotional, spiritual, sexual, and relational health during my supposed 'health' scan. Although I appreciate that things like blood sugars and blood pressure can contribute to some serious health problems for certain people, alone the measurements taken during my 'MOT' did not paint a comprehensive picture of my health and wellbeing. After all, the World Health Organisation defines health as “A state of complete physical, mental and social well-being and not merely the absence of disease or infirmity” (1). Whilst I appreciate that I live in a culture that champions lower body weight and smaller bodies - much to my dismay - I really struggle to understand how the size of my waist, my height, and my weight can accurately reflect the state of my physical health. And yet, since my blood pressure and blood sugars were within the 'normal' range, the focus of my health "MOT" was on just that. I'd already determined that my "MOT" was not able to define my overall health and wellbeing, but I figured I'd might as well look in to whether its focus on weight and body measurements is a valid in terms of measuring my physical health. Here's what I found:
Whilst there's plenty of evidence suggesting a correlation between BMI and waist measurements in relation to various physical health conditions, this does not mean that there's sufficient scientific and empirical evidence to reflect causation. That's just Science 101. And actually, some research has shown that BMI has a limited capacity to accurately identify excess body fat or to discriminate between lean body mass (which constitutes the majority of our body's mass) (2). It also neglects to take in to consideration how negative health outcomes associated with 'obesity' and 'fatness' are also correlated with fat-stigma, reduced access to health care, and other barriers to health experienced by individuals with a higher BMI (3)(5) (6). Not to mention the negative social, relational, and emotional consequences that people with higher body weight experience in our culture (4) (5) (6) and how the stress and anxiety associated with them also contribute to various negative health outcomes. And finally, the ways in which individuals with higher BMI are encouraged to manage their weight (like dieting and restricting certain foods) have also been shown to actually increase weight over time due to metabolic disturbances (5) (7). Basically, when our bodies aren't getting enough food, our metabolism slows down in an attempt to keep us alive by holding on to all the energy it can and storing extra fat.
Confused? Having a strong emotional reaction? Yeah, I don't blame you. That's because what I'm talking about here conflicts with what we are conditioned to believe about weight and health.
Ultimately, the idea of a 'Health MOT' - however well intending it may be - perpetuates socio-cultural messages about how the shape and size of our bodies is a direct reflection of our overall health and wellbeing. It also contributes to the lack of trust we have in our bodies by suggesting we need to be told what to do by others in order to be healthy, which arguably plays in to capitalist diet culture and fat-stigma. It also presumes that every body requires the same things in order to be 'healthy', such as: to be within a specific BMI range, to exercise and have a strong core, and to eat a specific way etc. Most importantly, it is not a holistic tool, and does not account for social or psychological / emotional components of our health as suggested by WHO. Finally, in my experience at least, it plays to the assumption that the reason why people go to the gym and exercise is to change body shape, size, and weight. Whilst this might be true for many people, I think it's problematic because it reflects unwell cultural values about how we perceive exercise and movement. There are plenty of other reasons to go to the gym...
Personally, I want to go to the gym to move my body. I feel positive and powerful when I move my body in certain ways - some more than others. Movement also helps me to feel de-stressed and re-energised. In addition, I feel so much more positive when I've moved my body because I wanted to instead of when I thought that I 'should'. So I don't want to be told, and feel, that I 'should' be doing particular exercises or shift my diet in order to change my body's shape, size, or weight. I spent enough time trying to do so when I was younger and it left me feeling unhappy, nursing recurring injuries, fixating on food (which led to increased shame and guilt), and fostering a general dislike for my body - which, for me, was incredibly unhealthy (in the holistic sense).
And this is why I cancelled the damn thing.
Ultimately, we tend to focus our attention and efforts on body shape, size, and weight, when in reality these are a reflection of what our bodies look like and not necessarily an accurate indication our overall health and wellbeing.
** The themes that I've explored here are a reflection of my own experience of a 'Health MOT', and the research that I've quoted is not by any means a comprehensive reflection of all of the research on the matter - this is just a blog post, after all. So I'm definitely not suggesting that we all cancel our gym memberships and never check our physical health. As I said, I feel that 'Health MOT's' are generally well intending and as such I don't mean to demonise them (or personal trainers for that matter) in any way. Rather, my intention in writing this particular piece has been to illustrate some of the problematic cultural messages and ideals that surround the concepts of 'health', weight, fat, and 'wellbeing' and to encourage you to think outside of the box. Also, if you're having a strong emotional reaction to this I would encourage you to delve deeper into the research and see what you find - but remember, correlation doesn't imply causation xx
2. Romero-Corrl, A. et al. (2008) "Accuracy of Body Mass Index to Diagnose Obesity in the US Adult Population". International Journal of Obesity (London), 32(6): 959-966.
3. Lee, J. A. & Pause, C. J. (2016) "Stigma in Practice: Barriers to Health for Fat Women". Frontiers in Psychology, 7 (2063).
5. Brewis, A. A. (2014) "Stigma and the perpetuation of obesity". Social Science and Medicine (118): 152-158.
6. Phelan, S. M. et al. (2015) "Impact of weight bias and stigma on quality of care and outcomes for patients with obesity". Obesity Reviews, 16 (4): 319 - 326.
7. Lowe, M.R. et al. (2013) "Dieting and restrained eating as prospective predictors of weight gain". Frontiers in Psychology, 4 (577).