It’s not you, it’s BMI. On Tuesday, the American Medical Association (AMA), the country’s largest group of doctors, voted on a new policy that encourages doctors to avoid relying on body mass index (BMI) when assessing a patient’s health and weight, citing racial bias.
BMI has long been used by the medical field in defining obesity and categorizing individuals as over-, normal-, or under-weight. Essentially, if you have a BMI of 30 or greater, you are considered to be obese. However, BMI “doesn’t actually measure fat mass, account for its distribution, or how those differ by age, gender, ethnicity, race, and how those differences affect health risks.”
It is widely known that “[a]nti-fatness and anti-Blackness are deeply embedded in the U.S. healthcare system.” Much of this bias can be traced back to slavery, where “white people used thinness to distance themselves from Black people.” Unfortunately, “[t]hese racist and fatphobic attitudes persisted, eventually becoming ingrained in public health policies, influencing how bodies are viewed and measured.”
When you look into its origins, it is unsurprising that BMI was invented by a Belgian named Adolphe Quetelet approximately 200 years ago. Quetelet, considered at that time to be an esteemed member of academia, was not a doctor nor did he study medicine. “Weight, what?” as a New York Post aptly quipped. He “was best known for his sociological work aimed at identifying the characteristics of l’homme moyen — the average man — whom, to Quetelet, represented a social ideal.”
In sum, BMI was invented by a white man “to measure weight in different populations of white European men.”
Since 1832, the medical field has utilized this measure to determine whether or not a patient is healthy. But Dr. Darien Sutton says that this historical overreliance on BMI has led “to poor quality care and specifically to Black women, who typically have higher levels of BMI compared to the average population.”
According to the AMA Council on Science and Public Health, “‘BMI does not appropriately represent racial and ethnic minorities’ because it is based on ‘the imagined ideal Caucasian’ of the 19th century, and does not take into consideration a person’s gender or ethnicity.”
“Our AMA recognizes: the issues with using body mass index (BMI) as a measurement because: (a) of the eugenics behind the history of BMI, (b) of the use of BMI for racist exclusion, and (c) BMI cutoffs are based on the imagined ideal Caucasian and does not consider a person’s gender or ethnicity,” said the Council.
BMI has faced ample controversy in recent years, and yesterday’s announcement was long overdue. As Dr. Cynthia Romero, who was an integral part in the creation of this new policy, says “Now we have to be truly more mindful and more holistic when it comes to patient care.”