Last Friday, several Bryn Mawr students received a personally addressed email from the Bryn Mawr health center. Bearing the subject line “Give a HOOT,” the email invited students to sign up for a weight loss program that was eligible for P.E. credit and run by athletic facilities, the health center and dining staff. The email described the program as a “fitness program for students with elevated BMIs.” The body mass index is a measure of body fat according to height and weight. Since the program is focused on students who have so-called “elevated BMIs,” it appears that students who received the email were chosen based — at least in part — on their records at Bryn Mawr’s health center.
The email sparked a range of reactions from the Bryn Mawr community. One junior, Rudrani Sarma, posted about the email in a Facebook status that garnered dozens of comments, most of which supported or identified with Sarma’s reaction. “Dear Bryn Mawr College,” read the status, “Sending your students a message ‘inviting’ them to take a weight loss class because they’re on a ‘list of students with elevated BMI’s’ is not ethical. It’s problematic, it’s hurtful, and it’s just plain stupid.”
“My first reaction to this was obviously horror. I felt awful to be targeted like that,” said Sarma. “I felt like it was an incredibly impersonal email and just incredibly unethical to receive something like this. I just thought of all of the other students that might have a problem with weight who received this email and how horrible they must feel.”
After posting her status, Sarma received many responses from other Bryn Mawr students, some of whom had also received the email.
“A lot of people responded with anger to the message itself,” said Sarma. “Health is so personal, and having this sent out was, for a lot of people, shocking … they felt violated.”
Heidi Gay, a Bryn Mawr senior who also received the email, thought that the College approached the issue in a counterproductive way.
“It’s not a terrible idea of a program, but they’re not doing themselves any favors by using languages that stigmatizes people who would even want to do it,” she wrote in an email.
In Gay’s eyes, Bryn Mawr has a responsibility to deal with health in a better way.
“The Health Center needs to understand that many, if not most of us, have received negative body image feedback at some point in our lives before Bryn Mawr, and probably will after Bryn Mawr,” she said. “Because we are a women’s college, it’s especially important that we start thinking about these issues — obesity, eating disorders, etc. without stigmatizing anyone … We need to prepare students to be confident in their bodies, no matter what, and to able to talk about these issues without feeling ashamed.”
Ava Hawkinson, also a junior, did not receive one of the emails, but engaged in the online conversations that followed. Hawkinson believes that the emails put forth an incomplete notion of health.
“It’s more concerned about weight than it is about actual health,” she said. “It is body policing, it’s size discrimination, it’s fat shaming, and I think all of those things are pretty terrible.” Hawkinson expressed doubt that Bryn Mawr can play a truly helpful role in promoting student health.
Noemí Fernandez, Swarthmore’s new wellness coordinator, shares Hawkinson’s belief in maintaining a broad definition of health, but thinks that colleges and college communities can play an active role in grappling with the breadth of what “health” is.
Swarthmore’s wellness program stands on five “pillars,” as Fernandez calls them, of health and wellness: intellectual, mental, physical, spiritual and sexual. Fernandez uses, and has written on her chalkboard, the World Health Organization’s definition of health, which reads: “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.”
For Fernandez, physical health is important, but is also highly tied to other forms of health.
“Physical health in particular is really the most obvious but sometimes the one that has the most myths revolved around it,” she said. “We experience physical health both as a result of lack of nutrition for ourselves, but also as a manifestation of unhealthy mental, intellectual, spiritual health too.”
Fernandez believes that colleges can actively promote this definition of health.
“My approach is really about education,” she said. “[It’s] about educating individuals and promoting programs and workshops that provide life skills, and then using those skills and workshops to build on bigger conversations about how the community portrays and works around issues of health … [and] promoting a culture of health that we both support and model as individuals, and as departments and as an institutions.”
With regards to BMI, Fernandez believes that it is useful, but only in limited ways.
“BMI is not necessarily the most accurate and best way of assessing someone’s healthy weight, for multiple reasons,” she said. “It is useful in the sense that you can use it to assess around where you are, but it is not the end-all be-all of what a healthy weight is.”
In a 2009 report titled “Body Mass Index: Considerations for Practitioners”, the Centers for Disease Control delineated several limitations of the BMI. Factors such as weight, distribution, ethnicity and age may distort the meaning of BMI in relation to actual relative body fat and health. Especially notable in the case of Bryn Mawr, the report also noted that women tend to have lower body fat relative to BMI than men. BMI is used over more precise or specialized measures of weight and health because it is cheap, efficient and can track the movements of populations over time.
The report states that “BMI is a reasonable indicator of body fat for both adults and children. Because BMI does not measure body fat directly, it should not be used as a diagnostic tool. Instead, BMI should be used as a measure to track weight status in populations and as a screening tool to identify potential weight problems in individuals.”
In light of these various concerns, Sarma and Gay both responded to the email and communicated with health center staff. The health center staff apologized to Sarma, informing her that her height had been incorrectly registered and had therefore mistakenly included her in the “list of students who would qualify for the program.” In issuing this apology, the health center confirmed for Sarma that there was indeed a “list” of students chosen for OWLS that was created using the medical data of those students. The response concluded by expressing an interest in further discussion between the Health Center and Sarma.
“I’m glad that they admitted that their mistake wasn’t an excuse … but at the same time, it was just a personal email to me, and it wasn’t apologizing to the community,” said Sarma. “I think that more apology is definitely necessary, both to individuals who received this email and have ‘elevated BMIs’ and to the general community for bringing this up in such a cold manner as well.”
In terms of wider changes, the response Sarma received pledged to improve the “screening processes” that resulted in the height mistake and to remove the first line of the email in the future. The first line reads “We want YOU to be in the Fitness OWLS (Onward to Weight Loss Success) Program.” The response stated that “while [the first line] personalizes the message for some, it could be disturbing for some of the people who may even be appropriate for the class.”
Gay was less impressed with the response she received.
“The response … quite frankly disgusts me even more and angers me for [the] unwillingness to take responsibility for the Health Center’s idiotic actions.”
The response to Gay focused on clearing up what the Health Center sees as “misconceptions” about the OWLS programs.
“Because we have limited resources, we are currently limiting enrollment to students who are most likely to get the most health benefit from the program, but it would be appropriate for anyone,” it read.
This explanation claims innocence on the part of the Health Center. According to the response, the emails were simply sent to provide their recipients with easier access to the OWLS program, and that any negativity coded in the email was inadvertent. The response went on to say that “there is no pressure for anyone to participate.” The email concluded by asking for “constructive feedback,” writing that “getting accurate information out to people when you can’t talk to everyone one-on-one can be quite challenging.”
Fernandez expressed sympathy for the Bryn Mawr health center regarding the difficulties they face in engaging with the student body.
“It’s sort of a chicken and egg problem. If you have a population of students that aren’t engaging in these conversations and you’re trying to reach them, how do you reach them without targeting them specifically,” she said. “It’s a difficult balance and we learn from mistakes. They tried this and they received a response and now as an institution you can use that and learn to go forward.”