The Bizarre and Racist History of the BMI

Overview of BMI and Its Controversial History

• Body Mass Index (BMI) is often viewed as a standard measure of health, but its origins and applications are problematic.
• Historically, BMI has been associated with stigma and has been used to label individuals negatively based on their size.

The Inception of BMI

• Invented by Adolphe Quetelet nearly 200 years ago, primarily as a sociological tool rather than a medical one.
• Quetelet aimed to quantify the characteristics of "l'homme moyen" (the average man) using measurements collected from predominantly white European populations, limiting its applicability across diverse groups.

Quetelet's Legacy and Racial Context

• Quetelet's work coincided with a rise in racist science; he co-founded positivist criminology, justifying social biases against certain racial groups.
• Quetelet's Index (now BMI) was misconstrued over time as a measure of individual health despite its design for population statistics.
• This misuse contributed to eugenics and other discriminatory practices targeting marginalized groups.

BMI's Transition into Medicine

• Early 20th-century insurance companies began using weight as a health indicator, informing medical practices but with flawed methods reliant on self-reported data.
• The 1970s marked a search for a standardized method of measuring body fat; Ancel Keys' research led to naming the index BMI.
• Keys emphasized the BMI's limitations, noting it could only diagnose obesity correctly about 50% of the time.

Official Recognition and Policy Impact

• In 1985, the NIH adopted BMI as a measure of obesity, tying it to individual health—a shift that institutionalized BMI in public health policies.
• Definitions of obesity were revised in 1998, which controversially labeled many individuals as "fat" without any change in actual body weight, contributing to widespread societal panic about obesity.

Modern Understanding and Critiques of BMI

• Recent studies have identified multiple types of obesity, challenging the simplification of fatness to a single measurement.
• Research indicates BMI inaccurately represents health risks, especially for people of color—overestimating fatness in Black individuals and underestimating it in Asian communities.
• The measurement does not account for sex-based differences, potentially misleading diagnosis and treatment for women.

The Persistent Stigma of BMI

• Despite evidence against its efficacy, societal norms and medical practices continue to utilize BMI as a primary health indicator.
• Discriminatory practices continue, such as employers incentivizing weight loss and requiring BMI reductions for accessing certain medical procedures.
• Ongoing adherence to BMI reflects a broader societal reluctance to accept more nuanced understandings of health and body diversity.

Conclusion

• The BMI's history demonstrates its limitations as a health measure, rooted in flawed science and racial biases.
• Calls for more equitable and comprehensive approaches to measure health are necessary to avoid perpetuating stigma and discrimination against larger bodies.