BMI: Hiding Fatphobia Behind the Veneer of Medicine
While there has been more critique of the Body Mass Index (BMI) metric (weight in kilograms divided by height in meters squared) in recent years, it is still widely used by healthcare professionals and Western media. While I am certainly not the first person to be pointing this out, the history of the BMI is steeped in racism and sexism. The BMI was created by a Belgian mathematician named Lambert Adolphe Jacques Quetelet in the 1830s using entirely white European men. By using only white European men, the metric was already flawed as a measure for the global population as a whole. Considering the entrenched and systemic fatphobia within healthcare, it is altogether unsurprising that BMI has become such a widely used metric for diagnosing what the medical industry and media call “an obesity epidemic”.
In the 1970s, American doctor Ancel Keys promoted the BMI using a study he conducted on only men. After this, the BMI was implemented by US medical professionals in the 1990s and by 2000 was adopted by the World Health Organization. Beyond the fact that the BMI was developed in a racist and sexist way, it also contributes to the moral construction of fatness as being unhealthy and bad. As the Western beauty standard of an incredibly thin person as the ideal has permeated globally, this has contributed to the moral construction of fatness as “bad” and thinness as “good”. The medical industry has been all too happy to promote this construction through the BMI, which reinforces this fatphobic idea that fatness is bad, and thinness is good. Constructing fatness as bad has also allowed the weight loss and dieting industries to be worth USD 224 billion in 2021. In that statistic I just linked and in any news articles on this industry, there is a rampant use of the BMI metric to define “obesity”.
In this sense, the BMI has also been a useful tool for corporations to sell weight loss and dieting products by defining what is healthy and what is unhealthy. Even as a skinny person, I remember how the BMI was harmful in making me perceive myself as unhealthy and too thin because my BMI was close to the underweight category in my second year of university. For my plus-sized partner, we have talked about how the use of BMI in medical settings is used to fat-shame her and how medical conditions are completely ignored because doctors assume that every health problem is tied into a high BMI. Doctors are then able to use these feelings of guilt and shame to proscribe expensive and harmful weight loss drugs and other procedures.
The construction of fatness as bad is also evident in the widespread use of the term “obesity” and “epidemic of obesity”. Because of how much the word “obesity” has been tied into notions of a lack of health and morality, it is unsurprising that it is used primarily as a slur to fat shame under the veneer of being a “medical” word. When medical professionals use this term, they are implying that the person being described is unhealthy and bad. In this way, fatshaming and fatphobia are used within the medical industry to reinforce heteropatriarchal beauty and health standards. After they have shamed their patients, they are then able to sell drugs or conduct surgeries that can have long-lasting and nasty effects. In the name of caring about their patient’s health, they can also deny them treatment for conditions until they lose weight or tell them that all their health problems are caused by their weight. This fatphobia is also also evident among trans people seeking to transition who are barred from doing so until their BMI is at a certain point.
In the US, in June of 2023, the American Medical Association for the first time urged caution when using BMI, but still came short of wanting to ban its use altogether. Even though the American Medical Association has acknowledged some of the racist and sexist history of the BMI, they still will not ban its use altogether. When the US adopted BMI in a widespread way in the 1980s, suddenly many new people were suddenly defined as fat or obese. The new definition of those people as fat underscores how fatness is a changing construct and how the “obesity epidemic” is part and parcel of Western society’s emphasis on constructing fatness as morally bad and unhealthy. Of course, as I have already pointed out, constructing fatness as unhealthy has led to many patients being denied care for various medical conditions because of their fatness (something which one might think would be thought of as bad for the patient’s health by doctors but apparently not).
I wanted to write this post not only to show how flawed the BMI is, but also to underscore how the medical industry contributes to and promotes the idea that fat people are less deserving of care, love and compassion. Having many conversations with my partner around internalized fatphobia has also shown how vigilant we must be in rejecting heteropatriarchal beauty standards and definitions of health. The idea that fat people are unhealthy and morally bad is pervasive throughout Western society, and it is necessary to constantly examine how we have been socialized into these beliefs and challenge them because fat and plus-sized people are just as deserving of care, love and compassion as anyone else.
