Body Mass Index: When Race Determines Health

The concept of a Body Mass Index was initially designed by Belgian statistician Adolphe Quetelet in 1832, whom created a formula based on his concept of the ‘average man,’ named the Quetelet Index. Louis I. Dublin, a Jewish naturalized- American, statistician and former vice president of a life insurance company, linked high mortality rates to overweightness, and in 1908, used the data of the company’s clientele to create the “Standard Table of Heights and Weights for Men and Women.” In 1972, American physiologist Ancel Keys sought to improve these measurements of overweightness and developed what is now known as Body Mass Index (BMI). With this new creation, Keys provided evidence that supported the industry-use of BMI as a global health indicator and easy way to determine a patient’s possible health outcomes.

There are many issues with BMI. To begin, the people both Dublin and Keys measured when developing their indices were predominantly of European-descent and white. In the case of Dublin, many people of color were excluded as outrageous premiums targeted at black people for insurance coverage kept many families away and uninsured. Though with so little diverse representation, Dublin still used his findings to give scientific legitimacy to the eugenics movement–a movement who viewed people of color as inferior. Both of these men and others believed that people of color were less than human and had no place in “civilized” spaces. As the dominate power, the slender aesthetic of the Anglo-Saxons, who believed themselves to be the beauty standard, was the expectation that both researchers based their ‘ideal weights’ on. These measurements helped normalize white racial superiority as any cultures or groups of people who held different standards were shamed and often called “savages.” 

Alongside racism and predetermined beauty standards, the BMI fails to differentiate between fat and muscle. Several studies have been released showcasing how BMI differs greatly between and among individuals in different racial/ethnic groups, and yet it has become a part of standard medical care. BMI tends to increase weight bias, which then affects how medical professionals treat different patients. In 2019, a series of studies by Alberga and colleagues found that weight stigma negatively influences health care (i.e. disrespectful treatment and condescension), and leads many patients to choose to forgo health care services entirely. Carr and colleagues (2022) found in their article that black adults, especially black women, classified as obese, were offered significantly less weight loss treatments and interventions by medical professionals. With obesity declared an epidemic in 1997 and then officially a disease by the American Medical Association in 2013, the ramifications of BMI classification becomes worse in a climate where not being the ideal weight was already set up to be racial and class indicators.

Currently, BMI is still the most convenient and widely used tool in clinical and research settings. However, there has been a push to include other tools in conjunction with BMI to offset some of the inaccuracies and inherent bias.

References

References:

Alberga, A. S., Edache, I. Y., Forhan, M., & Russell-Mayhew, S. (2019). Weight bias and health care utilization: A scoping review. Primary Health Care Research & Development, 20(e116). https://doi.org/10.1017/s1463423619000227 

Blackburn, H., & Jacobs, D. (2014). Commentary: Origins and evolution of body mass index (BMI): continuing saga. International Journal of Epidemiology, 43(3), 665–669. https://doi.org/10.1093/ije/dyu061 

Carr, L. T. B., Bell, C., Alick, C., & Bentley-Edwards, K. L. (2022). Responding to health disparities in behavioral weight loss interventions and COVID-19 in black adults: Recommendations for health equity. Journal of Racial and Ethnic Health Disparities, 9, 739–747. https://doi.org/10.1007/s40615-022-01269-8 

Dublin, L. I. (1952). Overweight, America’s #1 health problem. https://collections.nlm.nih.gov/catalog/nlm:nlmuid-2934149RX301-leaf

Eknoyan, G. (2007). Adolphe Quetelet (1796-1874) the average man and indices of obesity. Nephrology Dialysis Transplantation, 23(1), 47–51. https://doi.org/10.1093/ndt/gfm517 

Haller, J. S. (1970). Race, mortality, and life insurance: Negro vital statistics in the late nineteenth century. Journal of the History of Medicine and Allied Sciences, 25(3), 247–261. https://www.jstor.org/stable/24622126

Healy, M. (2013). AMA declares obesity a disease. Los Angeles Times. https://www.latimes.com/science/la-xpm-2013-jun-18-la-sci-obesity-disease-20130619-story.html 

Heymsfield, S. B., Peterson, C. M., Thomas, D. M., Heo, M., & Schuna, J. M. (2015). Why are there race/ethnic differences in adult body mass index-adiposity relationships? A quantitative critical review. Obesity Reviews, 17(3), 262–275. https://doi.org/10.1111/obr.12358 

Keys, A., Fidanza, F., Karvonen, M. J., Kimura, N., & Taylor, H. L. (2014). Indices of relative weight and obesity. International Journal of Epidemiology, 43(3), 655–665. https://doi.org/10.1093/ije/dyu058 

Strings, S. (2019). American beauty: The reign of the slender aesthetic. In Fearing the Black Body: The Racial Origins of Fat Phobia (pp. 122–146). NYU Press. http://www.jstor.org.libweb.lib.utsa.edu/stable/j.ctv335kw2p.8