Insa Birkenhagen discusses how BMI (Body Mass Index) is outdated and inherently racist.
For nearly two hundred years, BMI has been measured as a way to define an individual's health on the grounds of height, weight and gender. This outdated method has been proven to not consider external factors that may influence the final figure. Alongside affecting the average person, BMI has been proven to be inherently racist, and it is particularly damaging to Black women’s health care.
In the 1830s, Belgian statistician Adolphe Quetelet created an Index to determine the characteristics of the average man, and therefore measure populations for sociological purposes. The Body Mass Index (BMI) calculates the ideal body type by taking into account height, weight and gender. Over time, BMI made its way into the healthcare system, where it has been misconstrued ever since. Contemporary discourses, notably the Body Positivity movement, have started to expose the shortcomings of BMI for years now. And whilst the bias of this measurement has become public knowledge, there is still little awareness of the inherent racism of BMI.
BMI's first introduction into the medical world was as a henchman of scientific racism, as it was a commonly used tool amongst so-called Eugenic scientists. Emerging in the late 19th century, the Eugenics theory was based on the belief that humankind could be improved through selective breeding. This theory gave rise to specific policies in many countries around the world, notably in Nazi-Germany in the 1930s, but also in the US, where eugenics provided the basis for The Racial Integrity Act in 1924.
With the decrease of Eugenics, BMI lost significance; it wasn’t until the 1970s that it reappeared as the measurement we know today. When health insurance companies started to increasingly use standard weight tables, the researcher Ancel Keys rediscovered Quetelet’s Index in order to develop ‘a more effective measure of weight’. It is perhaps unsurprising that the studies Keys conducted to determine the BMI lacked diversity, as it only included male participants of predominantly western European countries. In the end, the history of BMI is a history of hegemony, ‘a continuation of white supremacist embodiment norms’ as Sabrina Strings, PhD at the University of California, puts it.
'In the end, the history of the BMI is a history of hegemony, ‘a continuation of white supremacist embodiment norms'
Therefore, the continued use of BMI by physicians to determine an individual’s health is a testimony of colour-blind racism, as it doesn’t take into account the differential composition of the body. For instance, White people typically possess more visceral adipose tissue - the tissue crucial for diseases commonly related to obesity, such as Diabetes Type 2. On the other hand, people of African descent present with more skeletal muscle mass, and Black women have more subcutaneous tissue, rather than visceral tissue. Simply put, Black people, especially women, will be of similar health ‘as their White counterparts while at a higher BMI’. Taking into account that young Black girls also experience their prepubescent weight surge earlier than their White peers, Black women are often subject to misdiagnosis and insufficient medical care from a young age.
Taking into account that young Black girls also experience their prepubescent weight surge earlier than their white peers, it seems black women are set up to face the possibility of misdiagnosis and insufficient medical care from a young age.
But the BMI isn’t only ignorant to the medical diversity of weight, for Black people are also at a higher risk of stress induced weight gain, due to their daily experience of racism and discrimination. Furthermore, because Black women often carry the burden of emotional care in their communities, they find themselves in a pool of factors impacting their weight, which are disregarded by their physicians.
When it was first conceptualised, BMI was not supposed to become an indicator of people’s health. Thus, not only was it exploited to introduce ‘fat’ as a health indicator, but it also contributed to upholding racist dynamics. At present, the BMI continues to ‘[racialize] fat phobia under the guise of clinical authority’, and is therefore outdated in a globalised world with postcolonial claims.