The Racist History of BMI
Hi Friends!
Welcome to Issue 44 of this newsletter. This week’s topic is The Racist History of the Body Mass Index (BMI). Lambert Adolphe Jacques Quetelet was a statistician (not a medical professional) who sought the specifications for the “average man” or l’homme moyen by predominantly measuring white men—and no women—to find a bell curve of data where the peak was considered “normal” and “everything differing from his proportion or condition, would constitute deformity or disease…or monstrosity.” This was during a boom of scientific racism and Quetelet is credited with co-founding the school of positivist criminology which laid the groundwork for criminologists like Cesare Lombroso, who believed that people of color were a separate species. The Quetelet Index took into account Quetelet’s ideal man based on body type, but was never supposed to be a measure of health. Remember, he was a statistician, and this index was designed to learn more about the average body size of the general male population.
Read more to learn how this index quickly became the BMI after insurance companies needed a way to determine a person’s coverage and refuse the “overweight”. When this system was designed with white men in mind (literally like everything else), it’s no wonder marginalized groups are misdiagnosed, discriminated against and shamed for their BMI, when the index was never created with their bodies in mind. Black women are especially demonized by the BMI scale, being the largest at-risk group based on the index—no shock there. Let’s get into it!
Key Terms
BMI (Body Mass Index): BMI is defined by the CDC as “a person’s weight in kilograms divided by the square of height in meters. BMI is an inexpensive and easy screening method for weight category—underweight, healthy weight, overweight, and obesity…BMI can be a screening tool, but it does not diagnose the body fatness or health of an individual. To determine if BMI is a health risk, a healthcare provider performs further assessments.”
Quetelet Index: Quetelet’s cross-sectional studies of human growth led him to conclude that other than the spurts of growth after birth and during puberty, 'the weight increases as the square of the height', known as the Quetelet Index until it was termed the Body Mass Index in 1972 by Ancel Keys (1904-2004).
Weight Bias: Negative attitudes, beliefs, judgments, stereotypes, and discriminatory acts aimed at individuals simply because of their weight. It can be overt or subtle and occur in any setting, including employment, healthcare, education, mass media and relationships with family and friends.
Obesity Stigma: Obesity stigma involves actions against people with obesity that can cause exclusion and marginalization, and lead to inequities – for example, when people with obesity do not receive adequate health care or when they are discriminated against in the workplace or in educational settings.
Obesity: The CDC describes obesity as " a serious chronic disease, and the prevalence of obesity continues to increase in the United States. Obesity is common, serious, and costly. This epidemic is putting a strain on American families, affecting overall health, health care costs, productivity, and military readiness.” They continue with, “Obesity impacts our nation’s health, economy, and military readiness…About 1 in 5 children and more than 1 in 3 adults struggle with obesity…Nearly 1 in 4 young adults are too heavy to serve in our military.” It also states on the CDC website, “weight that is higher than what is considered healthy for a given height is described as overweight or obesity. Body Mass Index (BMI) is a screening tool for overweight and obesity.”
Let’s Get Into It
The Origin Of BMI
Lambert Adolphe Jacques (22 February 1796 – 17 February 1874) was a mathematician, astrologer and statistician in Belgium during the mid-19th century.
He wanted to categorize the average man” (l’homme moyen, in French) and define what he looked like, an idea that already hinted that some people were inherently below average and, therefore, inferior to others.
Quetelet is credited with co-founding the school of positivist criminology, “which asserted the dangerousness of the criminal to be the only measure of the extent to which he was punishable.” That positivist school laid the groundwork for criminologists like Cesare Lombroso, who believed that people of color were a separate species. Homo Criminalis, Lombroso argued, were “savages” by birth, identified by physical characteristics that he claimed linked them to primates. This was the booming era of scientific racism — read my newsletter on that here.
“If the average man were completely determined, we might consider him as the type of perfection,” he wrote in his book A Treatise on Man and the Development of His Faculties. “And everything differing from his proportion or condition, would constitute deformity or disease ... or monstrosity.”
Quetelet believed that the mathematical mean of a population was its ideal, and his desire to prove it resulted in the invention of the Index, a way of quantifying l’homme moyen’s weight.
He created the Quetelet Index by using a calculation involving a weight-to-height ratio and set out to determine "the ideal."
He started with human physical features, like the chests of Scottish Highland regiment soldiers, and moved on to moral and intellectual qualities including suicide, crime, madness, and even poetic ability.
The features measured primarily were those of caucasian men. (I can’t find any research that mentions ANY non-white men whatsoever, but also haven’t found anything that definitively says it was ONLY white men.)
Instead of labelling the peak of the bell-curve as merely normal, he labelled it ‘ideal’, with those deviating either ‘overweight’ or ‘underweight’ instead of heavier than average or lighter than average. He envisioned the normal (i.e., typical) as the ideal or something desirable.
Quetelet never intended that this index be used to measure a person’s health or wellness. “Initially it was used to categorize people and look at the distribution of a population,” says Diana Thomas, Ph.D., a professor of mathematics at West Point.
“By the turn of the next century, Quetelet’s l’homme moyen would be used as a measurement of fitness to parent, and as a scientific justification for eugenics — the systemic sterilization of disabled people, autistic people, immigrants, poor people, and people of color.”
How Did BMI Become The Standard In Medicine?
In the late 20th century, health and life insurance companies adopted the Quetelet Index to replace their own height-weight tables (which were already based on stats drawn from mostly white men and some white women).
At the time, it seemed “simplest and most informative to express the weight of the individual as a percentage of the average weight of persons of the same height, age and sex in the population to which he belongs. That was the reasoning that led to publication of standard height-weight tables by the life insurance industry, beginning with the Medico-Actuarial Mortality Investigations of 1912.”
Insurers could use this information to determine a person’s coverage and could refuse to cover the “overweight” while many doctors saw these “medico-actuarial tables” as a quick tool to decide who they’d take on as a patient.
In 1972, Ancel Keys, a physiologist who studied diet, claimed he had a tool that was more accurate then the previously mentioned height-weight tables.
Keys and his colleagues did a large study on fatness, looking at predominantly white European and American men and concluded that the Quetelet Index, or the “body mass index,” was the most useful tool.
The researchers’ subjects were drawn from predominantly white nations (the United States, Finland, Italy), along with Japan and South Africa, though their study notes that findings in South Africa “could not be suggested to be a representative sample of Bantu men.” Most of their findings, the authors note, apply to “all but the Bantu men.” That is, Keys’ findings weren’t representative of, or applicable to, non white men. Today, there is a push for Asian populations to have a different scale for BMI, proving that even the Japanese subjects used in this study were not the intended demographic.
Problems With Using BMI As A Measure Of Health
When white men are the standard for “normal” and “ideal” bodies and their dimensions are seen as the most healthy, it’s no wonder other racial groups and genders are viewed as abnormal.
The standards for BMI, based on the bodies of white men, have been applies globally, “like in Central Africa where white people are the minority.”
According to an article from NPR, the formula for BMI itself is nonsensical. “There is no physiological reason to square a person's height. Moreover, it ignores waist size, which is a clear indicator of obesity level.”
It is physiologically incorrect because “it makes no allowance for the relative proportions of bone, muscle and fat in the body.”
Global acceptance of BMI doesn’t take into account that higher or lower BMI might be more appropriate for certain groups. “A large 2003 study published in The Journal of the American Medical Association (JAMA), for example, has shown that higher BMIs tend to be more optimal for Black people, and that Black women don’t necessarily show a significant rise mortality risk until a BMI of 37.”
Many people with “high” BMIs are healthy. 47% of people categorized as having overweight BMI are metabolically healthy. Using BMI perpetuates weight bias. Claiming “obesity is bad” without considering other “genetic, social and environmental factors harms more than it heals.”
Maria Monge, M.D., director of Adolescent Medicine at Dell Children’s Medical Center, says: “Many of my [larger-bodied] patients have been told that they’re not healthy, but when I checked their labs and vital signs, everything was pristine,” says Dr. Monge. “The only thing that was out of the range considered 'normal' was their BMI.”
BMI And Its Negative Impact On Marginalized Groups
BMI doesn’t take into account important social factors related to health. "One of the greatest predictors of health outcomes is socioeconomic status,” says to Kim Gould, MS, LMFT, a therapist, a Health at Every Size personal trainer, and the owner of Autonomy Movement. “Socioeconomic status tells us whether we can afford health care, have access to medical treatment, nutritious foods, and opportunities to move our bodies. It also determines our quality of sleep and how high our anxiety levels are. If our bodies are in a state of fight or flight and there’s cortisol pumping through our systems long-term, that’s destructive."
BMI is especially problematic for Black women. According to the U.S. Department of Health and Human Services’ Office of Minority Health (OHM), Black women have the highest rates of "obesity" and being “overweight.” These health assessments often fail to consider how chronic stress, economic inequality and institutionalized racism affect Black women in America, never mind the fact that these index was designed with white men in mind.
Studies show that “racial discrimination is associated with increased body mass index (BMI) and obesity among [ethnic minorities]…[and] this association strengthens with increasing time in the United States.”
I know many friends, coworkers and fitness professionals read my newsletter. Friends, let’s do better for our communities, clients and for ourselves. While we have all become accustomed to hopping on the scale for our yearly physicals, it’s not even necessary for patients to be weighed unless their prescription dosage is based on body mass or for specific medical tests. We need to break the cycle of fat stigma, discrimination and sexism that the Body Mass Index perpetuates. See ya next time!
