Anti-fatness and anti-Blackness are deeply embedded in the U.S. healthcare system. Therefore, a metric to categorize a person’s weight would be innately flawed if it didn’t address the implicit bias attached to these sentiments. Yet, despite being based solely on research done on white men, the Body Mass Index (BMI) has been integral in determining people’s health based on weight, devoid of race, sex, and gender (NPR). Even with growing criticism over its validity, racist BMI weight measuring continues to be used by healthcare providers and insurance companies, potentially preventing marginalized people from receiving adequate care and treatment.
The racial origins of anti-fatness can be traced back to the transatlantic slave trade and the 18th century when white people used thinness to distance themselves from Black people.
When we’re in the colonies, we’re noticing that Africans are sensuous. They love sex, and they love food. And for this reason, they tend to be too fat. Europeans, we have rational self-control. This is what makes us the premier race of the world. So in terms of body size, we should be slender, and we should watch what we eat.”
Sabrina Strings, author of Fearing the Black Body: The Racial Origins of Fat Phobia, interview via NPR.
These racist and fatphobic attitudes persisted, eventually becoming ingrained in public health policies, influencing how bodies are viewed and measured.
• Support the #NoBodyIsDisposable movement to resist the “triage discrimination” that fat and disabled people experienced during the COVID-19 pandemic.
• Watch the Profiles in Fatness series that examines the history and continued prevalence of fatphobia while celebrating forgotten fat heroes.
• Consider: how does the fixation on weight impact the health and wellbeing of fat people, specifically those who are not cis-gendered white men?
BMI is a universal standard for assessing weight and is often used to determine body fatness or someone’s health (Center for Disease Control Prevention). It’s calculated by taking a person’s weight in kilograms divided by the square of height in meters. This calculation determines whether an individual falls into four categories: underweight, healthy weight, overweight, and obese (CDC). However, it is far from being universally accurate in determining the objectives healthcare providers apply it to.
Studies have found that using BMI weight measuring wasn’t accurately identifying obesity among many U.S. adult women and were assigning lower BMIs to Black people, despite data showing obesity and type 2 diabetes rates were higher (Obstetrics & Gynecology, The Endocrine Society). These discrepancies occur because the categorizing system does not factor in a person’s gender, sex, age (except if you’re a child or teen), race, and ethnicity, which affects one’s weight.
“The correlation between the BMI and body fatness is fairly strong, but even if two people have the same BMI, their level of body fatness may differ. In general:
At the same BMI, women tend to have more body fat than men.
At the same BMI, Blacks have less body fat than do whites, and Asians have more body fat than do whites.
At the same BMI, older people, on average, tend to have more body fat than younger adults” (CDC).
They also occur because the creator never intended for it to do so. Originally, the “Quetelet Index,” the scale was created by Belgian mathematician Adolphe Quetelet in 1832 to measure weight in different populations of white European men.
Quetelet never studied medicine and was mainly credited for his work in sociology, which was deeply flawed. Some highlights:
He coined the concept l’homme moyen, or the notion of the ideal man, which was determined by measuring human features and characteristics. It would later be used to justify eugenics (Medium).
He co-founded the basis of the positivist school of criminology, which linked social causes to crime. He felt morally defective people, who could be identified through characteristics like the face and head, were predisposed to commit crimes. He was the predecessor to Cesare Lombroso, a criminologist who thought people of color were a subspecies, savages and animals, and prone to criminality (Encyclopedia, WIRED).
The Quetelet’s Index was reintroduced and co-opted in 1972 by researchers looking for a metric to measure obesity. Like Quetelet, they conducted a study that largely centered on whiteness but rebranded it to the Body Mass Index and used it as a cost-effective and more “preferable” but “not fully satisfactory” way to measure weight (International Journal of Epidemiology). The National Institutes of Health later adopted BMI and used it to measure individual weight and health, contrary to the intentions of Quetelet and the researchers in the ’70s (Slate).
Today, racist BMI weight measuring is used to create blanket health standards that superficially label those with higher BMIs as unhealthy and lower ones as healthy without properly examining a patient’s health beyond their weight (Nature). As a result, marginalized people are penalized by their employers and insurance companies, go undiagnosed, and are withheld life-saving procedures to uphold a faulty, sexist, racist, fatphobic metric that was never made for them.
• Fatphobia and racism have had deep ties in the U.S. and worldwide since colonialism.
• BMI weight measuring was created from research that excluded women and people of color.
• People with higher BMIs are denied treatment and life-saving surgeries until they lose weight.