Body Mass Index is a weight-to-height ratio used by health care providers, insurance companies and the scientific community and there is growing medical criticism for the use of BMI.
It doesn’t take body composition (fat versus muscle) into account, and a person’s weight doesn’t correlate directly with their health and there’s not much discussion about its racist roots or the way it oppresses and discriminates against certain groups.
Created by Belgian mathematician Adolphe Quetelet in 1832 as the “Quetelet Index,” the scale was created by data from predominantly European men to measure weight in different populations. Reintroduced in 1972 as the Body Mass Index it has since been adopted by the medical community as a way to measure individual health.
“It is racist, and also sexist, to use mostly white men within your study population and then try to extrapolate that and create norms and expectations for women and people of color,” said Sabrina Strings, an assistant professor at the University of California, Irvine. “They have not been included in the initial clinical analyses, and therefore their actual health outcomes cannot be determined by these findings.”
The way BMI is being used is unscientific because of its origins and the homogenous population it was created from.
“At present day, [BMI] has been widely adopted by the medical world as a shorthand for healthy or unhealthy,” said Jennifer Gaudiani, an internal medicine physician and certified eating disorder specialist based in Denver, Colorado. “That fact is unscientific and harmful.”
It can blind physicians to a patient’s actual medical conditions. The same thing happens to people at higher weights, who often don’t get screened for eating disorders despite things like significant recent weight loss, symptoms of malnutrition or reported eating disorder behaviors.
“I think that racism has a multi-system impact on the body,” said Lesley Williams, a family medicine physician and certified eating disorder specialist based in Phoenix, Arizona. “It’s waking up every day and dealing with micro- and macro-aggressions that you’re maybe not even familiar with but your body is absorbing ... It has an impact on stress levels, which can then increase cortisol levels, which then impacts the body’s composition.”
While discrimination and lack of access to quality medical care can affect BMI, they can also simultaneously be the result of a higher BMI ― an endless cycle.
BMI won’t disappear overnight, nor will racism or discrimination against those at higher weights. But the number of physicians and other experts beginning to reject, or at least seriously question, its validity as a tool for measuring health is growing.
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