Is using the BMI calculator up holding racist and sizest systems within our health service? YES!
Mokita Training and Consultancy
Equality Diversity Trainers specialising in critical race theory within health and Education
In the world of healthcare, certain metrics are considered gold standards, guiding decisions from treatment plans to eligibility for medical interventions. But what if one of these metrics isn't as neutral as it seems? Enter the Body Mass Index (BMI), a ubiquitous tool used to assess an individual's health based on their weight and height. On the surface, it appears innocuous, but delving deeper reveals a troubling history intertwined with racism, eugenics, and outdated notions of health.
So, are we inadvertently upholding white supremacy and perpetuating racist structures by relying on the BMI as a measure of health? And if so, what are the implications for healthcare providers and individuals alike?
Let's unpack this complex issue, exploring the origins of the BMI, its ties to racist ideologies, and its impact on healthcare practices today. Through this exploration, we'll uncover uncomfortable truths and consider the urgent need for a more equitable approach to health assessment.
As we unravel the complex history of the BMI, we find that its disturbing origins are deeply entwined with racist ideologies and eugenics.
Developed in the 19th century by Adolphe Quetelet, a Belgian mathematician, BMI was conceived within a context of burgeoning scientific racism and eugenicist thought.
Quetelet's work was heavily influenced by Francis Galton, a pioneer in eugenics and cousin of Charles Darwin. Galton propagated the belief in "biological determinism," which asserted that human traits, including intelligence and moral character, were genetically predetermined. This pseudoscientific framework laid the groundwork for the eugenics movement, advocating for the selective breeding of humans to improve the genetic quality of the population.
BMI, initially known as the Quetelet Index, was introduced as a means to quantify the "average man" based on data collected from white European men. The equation, weight in kilograms divided by height in metres squared, was never intended to assess individual health but rather to measure the characteristics of populations. Yet, its adoption as a tool for evaluating individual health status has perpetuated harmful stereotypes and biases.
Furthermore, the BMI was originally developed based on data predominantly collected from white European men, effectively excluding diverse populations from its calculations. This Eurocentric bias renders BMI unsuitable for assessing the health of individuals from the global majority. It fails to account for variations in body composition, bone density, and other factors that may differ across racial and ethnic groups. Consequently, BMI perpetuates health disparities by imposing a Western-centric standard of health that overlooks the diverse range of human bodies and experiences worldwide. By centring the health of a select demographic, BMI marginalises and discriminates against individuals whose bodies do not conform to this narrow 'standard', reinforcing harmful stereotypes and biases.
The eugenics movement gained traction in the early 20th century, particularly in the United States and Europe, where it informed policies ranging from immigration restrictions to forced sterilisation, yes that's right forced sterilisation did also happen in the UK, and it wasn't that long ago. BMI became intertwined with these discriminatory practices, serving as a metric to classify individuals into categories of "desirable" or "undesirable" traits based on race and size.
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Fast forward to the present day, and the legacy of BMI continues to reverberate in healthcare systems worldwide, including the UK. Despite growing awareness of its limitations and biases, BMI remains a cornerstone of health assessment and treatment eligibility criteria.
In addition to its problematic history, the Body Mass Index (BMI) fails to capture the nuances of individual health. It does not differentiate between types of weight, such as unhealthy body fat versus muscle mass. For instance, athletes with high muscle mass may be classified as obese by BMI standards, despite being in excellent health. Moreover, BMI has not evolved to reflect changes in diet and lifestyle over time. With improved access to quality food and better dietary practices, the equation used for BMI calculation may no longer accurately reflect contemporary health realities. As such, relying solely on BMI as a measure of health may lead to misinterpretations and inaccurate assessments, highlighting the need for more comprehensive and inclusive approaches to health assessment.
Let's look at the realm of reproductive health, BMI thresholds are often used to determine eligibility for fertility treatments like in-vitro fertilisation (IVF). Many UK healthcare providers adhere to strict BMI cutoffs, denying access to IVF for individuals deemed above a certain BMI range. However, research suggests that BMI is a poor predictor of IVF success and may contribute to unjust disparities in access to care. Another example, women and birthing people who are deemed to have a high BMI are often recommended to have growth scans later in their pregnancy due to their BMI, despite research suggesting that a high BMI may not give an accurate reading, and therefore this could be one of the factors leading to an increase in c-sections. It should also be noted that this area of medicine is hugely under-researched, which in itself is very problematic.
Furthermore, BMI-based guidelines for weight management and disease prevention fail to account for the diverse range of human bodies and health experiences. They perpetuate stigma against larger bodies and reinforce harmful stereotypes about race and size, disproportionately affecting marginalised communities.
In light of this troubling history and its contemporary implications, it is imperative to challenge the entrenched use of BMI in healthcare. By advocating for alternative approaches to health assessment that prioritise inclusivity and equity, we can work towards a healthcare system that truly serves the needs of all individuals, regardless of race or size. Let us confront the racist legacy of BMI and interrogate our current policies. we can strive for a future where health is not determined by arbitrary metrics but by holistic, patient-centred care.
References:
Bjorklund J, Wiberg-Itzel E, Wallstrom T. Is there an increased risk of cesarean section in obese women after induction of labor? A retrospective cohort study. PLoS One. 2022 Feb 25;17(2):e0263685. doi: 10.1371/journal.pone.0263685. PMID: 35213544; PMCID: PMC8880764.
Hicken MT, Lee H, Hing AK. The weight of racism: Vigilance and racial inequalities in weight-related measures. Soc Sci Med. 2018 Feb;199:157-166. doi: 10.1016/j.socscimed.2017.03.058. Epub 2017 Mar 28. PMID: 28372829; PMCID: PMC5617791.