Ethics, BMI, and PR disasters

My alma mater has been in the news, thanks to an exceedingly ill-considered e-mail offering a weight loss program to select students. Said selection was made using students’ BMI data, leading to student outrage and headlines regarding fat-shaming. (Or “fat-shaming,” which I can only assume means some news outlets aren’t entirely sure fat-shaming is a thing and not just, I don’t know, all those liberal girls getting hysterical about their looks.)

Programs focusing on weight loss are not a particularly great idea. Helping people lose weight and keep it off is notoriously difficult and of dubious benefit. (I say this as someone who has been able to lose a non-trivial amount of weight and keep it off for a non-trivial amount of time.) I appreciate the temptation to work owls into everything, but Fitness O.W.L.S (Onward to Weight Loss Success) is not a good way to brand a course that’s legitimately concerned with developing a healthy lifestyle. At best, it sounds like the exercise-more-and-don’t-eat-crap advice which (while probably good, insofar as modern American life promotes sedentary behavior and the consumption of ingeniously engineered crap) does not necessarily lead to weight loss. It certainly should not lead to significant weight loss over the course of eight weeks, and weight loss is explicitly framed as a goal.

Fitness? Nutrition? Everything else in this screen shot? No objections here. (Twenty years ago, I took a fitness course that probably had a similar description, sans the weight loss; it was a pre-requisite to self-paced gym classes, which probably did more to help encourage integrating exercise into daily life than showing up to the gym at the same time for a few weeks in a row.) I don’t even have a particular problem in pre-screening for eligibility. BMI is better considered a broadsword than a scalpel, so if that were the only thing the Health Center looked at in their “screening” I’d write them off as not really screening so much as holding up a hoop and, perhaps, missing important details like whether a student’s history included eating disorders or more complicated metabolic issues that might make a generalized weight loss plan a particularly dodgy idea. But still, it would be a voluntary, student-driven thing.

The ethical concerns about this mailing are real. I assume everything’s kosher from a HIPAA perspective, but that doesn’t change the sense of privacy violations that can damage community trust, to say nothing of students’ entirely reasonable feeling that they were being judged. I’m glad students are pushing back. I hope it results in thoughtful policy reassessment, not just additional poorly-worded apologies; but at a minimum, student voices are out there. From a Hippocratic perspective, it’s a mess. There are college students who have–or are at risk for developing–eating disorders. When your patients are primarily women between the ages of eighteen and twenty-two, that really should be on your radar.

When I was a student, the Health Center–better known as the Death Center–was viewed as (at best) benignly clueless. If you came in with any injury or complaint, they would ask if you were pregnant. If you had a pelvic exam, they would ask if you wanted to see your cervix. Sharing eye-rolling Death Center stories was a popular pastime. My needs were pretty routine; I was happy about that at the time, and even happier in retrospect. (My cervix is not particularly interesting, visually speaking. And now that I think of it, I don’t believe they asked me if I was pregnant when I came in with a broken foot, in an initial stop before proceeding to the hospital and an X-ray.) But I also heard anecdotes of a much more serious nature, including misdiagnoses. (Ironically, one of my friends whose medical issues did not include anorexia was assumed to have an eating disorder.) The Fitness O.W.L.S. fiasco is itself mainly a failure of communication, but it implies a set of more serious concerns about those entrusted with students’ health and well-being. Fat-shaming is a big and complicated part of the problem, but it’s not the whole problem.

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