Abolish the BMI

I was in the pediatrician's office for my daughter's 2 year old check up. We were seeing another doctor in the practice that day. My baby girl had been weighed and measured by the nurse and her measurements were plotted on the pink growth charts. She was tracking beautifully and following her curve. "Her BMI is high, have you considered giving her fat free milk?" I had to pick up my jaw from the floor. I must have heard incorrectly. What? I'd like to say that I used this opportunity to educate this doctor about BMI, about how it is a useless metric, about how we can talk about health without fat shaming patients. I'd like to say that I shared with him how damaging comments about weight can be. Especially to children. Especially to little girls. Especially in this horrible diet culture. Unfortunately my fierce Momma Bear protection took over me and I informed him that not only are we not going to switch from breast milk to fat free cow's milk, but that we were not going to have a conversation about weight today. Especially when she has been on the same track since birth. Especially in front of her.

Children and adults are having their health, and much worse, their worth, plotted on a graph every time they go to the doctor. I have clients who avoid going to the doctor so that they don't have to have that conversation. And for what? If BMI had any value, I would be open to discussing it. But it doesn't. Never had, never will.

I am a proud member of the Association for Size Diversity and Health. One of their missions is to abolish the BMI. Here is their mission statement:

We envision a world where BMI does not exist, and is not replaced with another size-based, anti-fat measure of health.

We envision a world beyond health, where we lean into our collective wisdom for our wellness. We envision a world where people of every size, especially fat, Black, Indigenous, disabled, and multiply marginalized people, have full body autonomy and access to healing-centered care and resources.

Let me share with you something that has changed things for me at the doctor's office. You DO NOT have to get on the scale.

So what is BMI? We can thank Adolphe Quetelet, a statistician and mathematician for this horrible metric. He WAS NOT a doctor, nor did he study medicine. He created this index in the 1830s studying white, European men. It was looking at statistical averages, and had little to do with overall health. Yet here we are today, in 2023, using this metric to assign value and health to every individual who walks into a doctor's office. It is inaccurate at best, affecting people of color disproportionately. According to studies by the Endocrine Society, BMI overestimates health risks for Black people and underestimates health risks for Asian people.

Medical discrimination based on BMI is real, and research continues to show weight bias in the medical field. BMI is racist, unnecessary, harmful and should be completely abolished. It continues to harm people who are living in larger bodies. The metric forces people of all ages, genders, body compositions and genetics to get evaluated on one set of numbers. This can result in feelings of guilt and shame for not being a part of the "healthy category". We've learned so much since the 1800s. We're better today than we were. Why are we still using this metric? The true beauty of the human race is that everyone is made differently. Let's celebrate our differences and accept that health can be at every size.

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