Criticism of the widespread use of the Body Mass Index (BMI) abounds among the eating disorder treatment and recovery community. Those struggling with or in recovery from eating disorders, eating disorder treatment professionals, the body positive community, Health at Every Size advocates, and fat activists all have rang the alarm bell on BMI, but barely a whisper of dissent made it into mainstream media. Until now. A few weeks ago, a particular Huffington post article by Christine Byrne started making the rounds on social media: “The BMI is Racist and Useless. Here’s How to Measure Health Instead”. And at Reasons, all we can say is, “It’s about time!”
Most of us know of the BMI as the go-to measure of… well what exactly does it measure? The BMI calculates “Body Mass Index” according to a simple weight-to-height ratio that excludes body composition. In 1832, a mathematician developed the BMI as a tool to study populations, not individuals. Fast forward more than a century later, and the BMI has somehow become the ubiquitous means for categorizing and demonizing body shape and size around the globe.
What’s the problem you say? Consider a few of these facts:
- The American Academy of Pediatrics recommends the use of the BMI as a screening tool for children beginning at age two.
- Children as young as age seven are being diagnosed with eating disorders.
- 80% of girls in the fourth grade have been on a diet.
- Dieting, body image dissatisfaction, internalized messages about what constitutes an “ideal body”, and weight stigma (i.e. the societal message that thin is “healthy” and fat is “unhealthy”) are all risk factors for the development of an eating disorder.
Last but not least, countless people recovering from a lifetime of disordered eating can pinpoint the moment they first felt deeply ashamed of their body. Often, that moment consisted of the day a doctor or teacher told their parent to start having them “watch their weight” after a routine BMI screening.
But wait, there’s more! As Byrne so helpfully outlines in her article, the roots of the BMI are fundamentally racist. The BMI was created using a homogenous group of white men. It isn’t accurate or scientific to use information from such a limited population study to create expectations for women and people of color. Leveraging a narrow, white male tool like the BMI to determine health for everyone also ignores the impact of minority stress, food insecurity, poverty, and the trauma of racism on health and weight. Beyond the BMI itself, when you combine the prevalence of weight stigma among medical professionals, with the disproportionate access to healthcare among minorities, a perfect storm emerges inadequate care that lacks cultural understanding and that often does more harm than good.
Sadly, the world is just waking up to the notion that eating disorders impact people of all races, genders, ages, abilities, and socio-economic status. Within the eating disorder treatment field, we have done patients and clients a great disservice by modeling treatment off of studies done primarily on young, white, cisgender women. In her article, Byrne frequently quotes Sabrina Strings, author of Fearing the Black Body: The Racial Origins of Fatphobia to highlight the ridiculousness of leveraging one racialized standard of health and wellness for a world of diverse people. As Byrne points out, throughout history the glorification of thinness serves as yet another tool to elevate whiteness as the “norm” for black and brown bodies to conform toward.
We applaud Huffington post for publishing Christine Byrne’s article, and Byrne for writing it. We are cheering on each and every one of our colleagues and friends who has shared this important piece over the last few weeks, and encourage more to do so. Through our words and our actions, Reasons is committed to moving away from a limited, unchanging approach to treating eating disorders and to healthcare. We hope you’ll join us.