3 images overlapping at the edges on a colored background with the title of the blog,"I hate being a mom_ and that's okay". 3 images of mothers of various ethnecities with their children in challanging poses, not everyone is happy, frustration is being expressed in all the images from the mothers.

In the realm of health and wellness, the term “BMI” has become ubiquitous. Standing for Body Mass Index, it’s often touted as THE measure of an individual’s health status, particularly in relation to weight. However, a closer examination reveals a deeply flawed tool rooted in outdated assumptions that continues to perpetuate health disparities, particularly among marginalized communities.

Understanding BMI: Origins and Concept

Body Mass Index (BMI) is a numerical value derived from a person’s weight and height. It’s calculated by dividing an individual’s weight in kilograms by the square of their height in meters. The result categorizes individuals into different weight classes: underweight, normal weight, overweight, and obese.

Unraveling the Myth of BMI: Flaws, Racism and the Perpetuation of Health Inequities

1832:  Adolphe Quetelet (1796-1874), a Belgian statistician, mathematician, and astronomer, introduces the Quetelet Index, laying the foundation for what would later become known as body mass index (BMI).

This marks the inception of BMI as a metric for assessing body composition. Originally created to show “superiority” of the average white European man.

1950s: Louis I. Dublin (1882-1969), statistician and vice president of Metropolitan Life Insurance Company, develops tables of weights for clients, contributing to the understanding of weight distribution in populations.

However, it’s notable that insurance companies like Metropolitan Life have financial stakes in managing “risk related to obesity”, influencing the framing and dissemination of medical information on fatness.

How Doulas Support the Non-Birthing Parent

1970s: Ancel Keys (1904-2004), a physiologist, coined the term “body mass index” (BMI) and advocated for its use in population studies as a simple and convenient measure of body fatness.

While Keys’ contributions are significant, it’s important to note that conflicts of interest may have arisen due to funding sources, including those from industries with interests in obesity management, such as pharmaceutical companies and weight-loss programs.

1980s: Widely recognized and publicized, the prevalence of “ob*sity” began to rise globally, leading to increased attention from researchers and public health authorities.

The influence of corporate interests, particularly from the food and beverage industries, in shaping public discourse and policy responses to this information.

1990s: The World Health Organization (WHO) formally recognized “ob*sity” as a global public health crisis during this decade.

Conflicts of interest related to the “ob*sity” epidemic are well-documented, with pharmaceutical companies and other stakeholders profiting from the sale of weight-loss drugs, supplements, and medical interventions.

These conflicts of interest again influence research agendas, treatment approaches, and policy decisions related to “ob*sity”.

1998:  U.S. National Institutes of Health brought U.S. definitions in line with World Health Organization guidelines, lowering the “normal/overweight” cut-off from a BMI of 27.8 (men) and 27.3 (women) to a BMI of 25.

This had the effect of redefining approximately 25 million Americans, previously healthy, to overweight.

2000s: BMI remains a cornerstone tool for assessing “ob*sity” prevalence and guiding interventions.

However, the influence of corporate interests in shaping “ob*sity”-related narratives and policies underscores the need for transparency and scrutiny in public health efforts.

Present: BMI is integrated into healthcare systems globally, serving as a fundamental tool for assessing health risks for those in higher BMI categories and guiding preventive measures.

Nevertheless, ongoing concerns persist regarding conflicts of interest among stakeholders and a push for independent research and policy-making processes.

One The Fallacy of Body Mass Index as a Health Indicator

The current utilization of BMI as both an assessment and predictive instrument raises concerns. Initially designed as a practical measure of relative body weight, BMI is now employed in medicine for assessing disease and health risks.

However, research indicates that BMI can be problematic in several ways: it may not accurately reflect cardiometabolic health indicators such as blood pressure and cholesterol levels, or lifestyle factors like physical activity and eating habits.

Furthermore, BMI’s predictive accuracy for health risks diminishes when applied across diverse human body types. In addition to its limitations as an identification tool, the practice of categorizing patient care based on BMI raises ethical concerns.

This stratification reinforces narratives that perpetuate anti-fat attitudes and discrimination, both within healthcare systems and in individual interactions.

Flaws in Application: Discrimination and Denial of Care

The flawed nature of BMI becomes particularly concerning when considering its real-world implications.

Despite numerous studies highlighting its inadequacy and a policy change from the American Medical Associate to distance BMI as a sole health measure, BMI continues to inform medical decisions and healthcare access, often to the detriment of marginalized groups, especially people of color and those in the LGBTQ+ community.

Postpartum Essentials - a line art drawing of a mother and father cradling each other and a newborn on the father's shoulder with a beige background with green water color circle and gold glitter accents

Racism Embedded in BMI

  • BMI’s roots in racism are undeniable. Its origins lie in the work of Quetelet, who used it to study the characteristics of the “average man,” a concept that was inherently biased towards white, European males. Over time, BMI has been weaponized to perpetuate stereotypes and discriminatory practices, particularly against Black and Brown bodies. 

Healthcare Disparities and Anti-Fat Bias

  • The reliance on BMI as a measure of health has led to widespread anti-fat bias within medical communities. Fat individuals often face stigma, discrimination, and denial of care based solely on their BMI. This bias extends to reproductive healthcare, where fat individuals are often denied fertility treatments or pressured into intentional weight loss based on their weight rather than their reproductive needs.

Moving Towards Equity and Inclusion

The persistent use of BMI as a measure of health underscores broader systemic issues within healthcare, including racism, anti-fat bias, and discrimination. By challenging the status quo and advocating for more inclusive and accurate measures, we can work towards dismantling these systems of oppression and promoting health equity for all individuals, regardless of their size, race, or identity.

As we continue to navigate discussions around health and wellness, it’s crucial to interrogate the tools and metrics we use and ensure they reflect the diverse realities of human bodies and experiences. Only then can we create a healthcare system that truly serves the needs of all individuals, free from bias and discrimination.

References:

  1. Bacon, L., & Aphramor, L. (2011). Weight Science: Evaluating the Evidence for a Paradigm Shift. Nutrition Journal, 10(1), 9.
  2. Campos, P., Saguy, A., Ernsberger, P., Oliver, E., & Gaesser, G. (2006). The epidemiology of overweight and obesity: public health crisis or moral panic?. International Journal of Epidemiology, 35(1), 55-60.
  3. Devlin, K. (2009, July 4). Top 10 Reasons Why The BMI Is Bogus. Weekend Edition Saturday. NPR. https://www.npr.org/templates/story/story.php?storyId=106268439
  4. Pray, R., & Riskin, S. (2023). The History and Faults of the Body Mass Index and Where to Look Next: A Literature Review. Cureus, 15(11), e48230. https://doi.org/10.7759/cureus.48230
  5. Saguy, A. C., & Ward, A. (2011). Coming out as fat: Rethinking stigma. Social Psychology Quarterly, 74(1), 53-75.
  6. Temple N. J. (2022). The Origins of the Obesity Epidemic in the USA-Lessons for Today. Nutrients, 14(20), 4253. https://doi.org/10.3390/nu14204253
Skip to content