Weight is such a loaded topic across society, and our healthcare system is no exception. Get a certain BMI number at your next checkup, then all sorts of new conversations and healthcare costs — from more tests to prescription drugs — can ensue.
However, there is a growing body of scientific literature — and cultural understanding — that BMI is not just an inadequate measure of health, it’s also a big part of structural racism that adversely impacts certain communities more than others.
The BMI standard was developed for an idealized Caucasian male, and the thresholds remain rather oblivious to important discrepancies warranted by gender and ethnicity. For example, there is evidence that Asian individuals hold onto visceral fat around the belly more, and can thus experience poor health outcomes from excess weight at lower BMIs. And Black women seem to handle much higher BMIs without the metabolic dysfunction that the averages would suggest.
Not to mention the non-racial flaws. Does a pound of lean muscle impact health the same as a pound of visceral fat? Of course not, but an athlete with greater bone density and muscle mass can easily register a high BMI. Same goes for pregnant and nursing women.
You get my point. You are not a number, and a healthy weight depends on so much more than your scale. It’s hurtful to reduce personal health to a number that takes no account of your behaviors and the socioeconomic pressures that play major roles in so many people’s lives. I’m talking about chronic stress and economic inequality. I’m talking about living in food deserts with polluted air and water.
These socioeconomic determinants of health — everything from education and housing to employment, criminal justice, and access to health care — matter, and our reliance on BMI as an easy shorthand for health only furthers the structural racism present in our current medicine.