Why Are People Fighting Over BMI? Conservatives Call Doctors’ Group ‘Woke’ For Questioning Obesity Measure

Topline

Right-wing pundits criticized the American Medical Association as “woke,” the latest target in an ongoing culture war, for a new policy urging doctors to consider more health factors than just body mass index (BMI), a weight measurement sometimes controversial because of its history of “racist exclusion.”

The AMA urged doctors to consider more health factors than just body mass index. (Photo by Frank … [+] Molter/picture alliance via Getty Images)

dpa/picture alliance via Getty Images

Key Facts

BMI—determined by taking a person’s weight and then dividing it by the square of the person’s height—is used in clinical settings to diagnose obesity and assess risk for health issues associated with obesity.

On the BMI scale, a “normal” weight is between 18.5 and 24.9, a score under 18.5 is considered underweight, between 25 and 29.9 is considered overweight, and 30 or greater is considered obese.

The American Medical Association adopted a new policy last week acknowledging the limitations of body mass index because of “its use for racist exclusion”—it was developed using data collected primarily from white male populations—suggesting BMI be considered alongside other clinical measures of risk instead of by itself.

The AMA policy states BMI strongly correlates with fat mass in the general public but loses predictability on an individual level, and other factors like sex, gender, race, ethnicity and age can influence body shape and composition.

The policy urges medical providers to consider BMI in conjunction with other measures, including “measurements of visceral fat, body adiposity index, body composition, relative fat mass, waist circumference and genetic/metabolic factors.”

The AMA policy comes after years of research identifying the limitations of BMI and criticism of the index from some medical providers and activists who argue an emphasis on BMI can contribute to weight stigma and is based on data collected primarily from white men.

Some right-wing pundits and social media users, including Ben Shapiro, ridiculed the policy and have considered the AMA’s acknowledgement of its history of “racist exclusion” to be “woke.”

Chief Critics

In a video titled, “BMI Is Now Cancelled?!” Shapiro ridiculed the AMA as “no longer particularly interested in medicine” and defended BMI as an accepted measure of weight. He stated: “It seems to me that much of what is driving the AMA these days is an attempt to get in good with the woke crowd,” pointing to the AMA’s defense of gender-affirming care as a “woke” policy, though the AMA states its support of gender-affirming care is backed by research that links treatment to lower suicidal ideation in transgender individuals. Fox News host Jeanine Pirro and NYU professor of medicine and Fox News contributor Mark Siegel similarly ridiculed the AMA’s policy in a segment Tuesday. “I didn’t believe that the AMA was going to get involved in cancel culture,” Siegel said, who defended BMI as a starting point for treating overweight patients. In a tweet to his more than 1.3 million followers, right-wing YouTuber Paul Joseph Watson seemingly mocked “body positivity people” who would “rejoice” at the new AMA policy.

Key Background

The body mass index measurement was developed by Belgian mathematician and statistician Lambert Adolphe Jacques Quetelet beginning in the 1830s. He did not intend for BMI to diagnose obesity but rather to measure the “average man.” Originally called the Quetelet Index, Quetelet conducted and published research on height and weight, first in newborns and children and then in adults. His pursuit to measure the “average man” was key for the development of eugenics. The term “body mass index” was later coined and popularized by physiologist Ancel Keys in 1972. The Keys study surveyed more than 7,000 healthy, mostly middle-aged men, and Keys and his colleagues found the index a suitable measure of weight in populations. BMI has been adopted by organizations like the World Health Organization and the National Institutes of Health to measure obesity, and BMI has persisted as an attractive option for doctors to measure a patient’s weight because it is simple and inexpensive.

Contra

But BMI has long been the target of criticism from some health providers and activists, particularly over its use to evaluate an individual’s health instead of a population. BMI is unable to distinguish body fat from muscle—so a person who has large muscle mass but low body fat may register as overweight on the BMI scale. Research indicates body compositions can vary across races and ethnicities, which some say makes BMI problematic as it is used to determine eligibility for some medications and surgeries. Some also argue the emphasis on BMI can contribute to stigma against overweight patients, which studies have shown is prevalent among doctors.

Crucial Quote

Dr. Yoni Freedhoff, an associate professor of family medicine at the University of Ottawa, told The New York Times BMI is “fairly useless when looking at the individual.” If a doctor assumes a patient with a “normal” BMI is healthy, this can cause doctors to overlook other health problems or poor dietary habits, Freedhoff said. Similarly, focusing on just the weight of a patient with an “overweight” BMI may cause a doctor to stigmatize the patient and overlook more important diagnoses.

Tangent

“Woke” has become a frequent insult used against companies and organizations by right-wing pundits and social media users for socially conscious behavior—like supporting Pride month or committing to diversity, equity and inclusion. Bud Light infamously faced a boycott in April after it sent transgender TikTok star Dylan Mulvaney a customized can with her face on it, leading to a dip in sales for the company and sparking a wave of boycotts and online protests against other companies deemed “woke.” Though “woke” is now frequently used as a political buzzword, its original meaning in African American communities was to stay aware of social and racial injustice.