October 2020 Issue

Editor’s Spot: Is the BMI Racially Biased?
By Judith Riddle
Today’s Dietitian
Vol. 22, No. 8, P. 6

Conversations about health care disparities continue on. One topic still being debated is the BMI. For years, health care practitioners and RDs alike have questioned whether the BMI is a valid measure of healthy weight and overall health for the masses. Critics say the BMI doesn’t account for body composition, physical activity level, body type, age, genetics, cultural diversity, or ethnicity, as there are differences in BMI and its associated health risks among African Americans, Asians, Indians, and other people of color.

Some health experts believe the BMI is a tool that “furthers the oppression of and discrimination against” African Americans and other people of color due to its origins, according to the article “The BMI Is Racist and Useless. Here’s How to Measure Health Instead,” published July 20 on Huffpost.com. The article says a Belgian mathematician first created the tool under another name in 1832, using data from European white men to “measure weight in different populations,” not to determine individual health. Physiologist Ancel Keys reintroduced the tool in 1972 as the BMI, and the medical community has since used it as a standard measure of individual health for the general population.

The reason some call the BMI discriminatory and even sexist is because it was based on a white male study population, whose data can’t be extrapolated scientifically to create a standardized measure of individual health for women and people of color. But the health care system continues to use it as such in these populations that were never part of the original cohort.

Experts say the BMI perpetuates the idea that the often-thinner bodies of whites are the standard to which everyone should be held and are therefore superior to the often-larger bodies of persons of African descent. They say using such narrow parameters to label those with larger bodies as unhealthy and overweight/obese has caused many persons of color to develop low self-esteem, depression, anxiety, eating disorders, and other health problems as they try to conform to an impossible weight standard. The same could be said for whites who don’t fall within the BMI parameters.

The best way to measure patients’ health, experts say, is to consider their background, stress levels, access to healthful foods, dietary and exercise habits, and other underlying health issues. Racial discrimination—and weight bias in general—against people with larger bodies won’t disappear overnight, but the medical community must hold itself accountable for its part in enabling these injustices with the use of the BMI.

This month, Today’s Dietitian continues the conversation about equality and inclusivity in the article “Ethics in the Plant-Based Food Movement,” on page 24. Please enjoy the issue!

— Judith Riddle, Editor