Laying the foundations for Eugenic History, Scientific Racism, Colonialism, Fat-phobia, Gender discrimination, Racial discrimination and Body Terrorism, Body Mass Index (BMI) centers itself at the heart of prejudices.
Deemed as a simple and non-invasive formula [weight (kg) / {height (m)}2], and often used to determine the existence of obesity, BMI has been under a lot of scrutiny, lately. In fact in January 2023, 6 obesity care institutions issued a statement saying "BMI is not a measure of Body Fat."
The BMI chart we use today bases its calculations upon a small demographic pool: the white Caucasian European men, making it highly unreliable for individuals belonging to different races and sexes, essentially a different genetic makeup than the average Caucasian. For example, those of an Asian descent seem to have a lower BMI cutoff point in comparison to individuals belonging to other ethnicities.
So how did Body Mass Index become the measurement for obesity and why?
BMI, earlier referred to as the Quetelet Index, was developed by Lambert Adolphe Quetelet, a Belgian astronomer, mathematician, statistician and sociologist, not a doctor, surgeon or a biologist, who created this formula in the mid-1800s. He was fascinated by how statistics could predict phenomena like crimes, suicide or marriage rates.
In 1835, he published his work, the Treatise of Man. Quetelet's goal was to find the physical and moral characteristics that make up the average man, which to him represented "a type of perfection, anything deviating from his proportions would constitute deformity and disease". Although, Quetelet was not a Eugenicist, his work fueled the ideas put forth by the Father of Eugenics, Francis Galton, and soon his calculations became the foundations for scientific racism.
Quetelet's research influenced bigoted scientists who justified racism, colonization, slave trade, eugenics, gender discrimination and body terrorism with the calculations he'd provided. This was along the same time, Darwin's natural selection theory was being published, paving the way for academics to compare and contrast measurable human traits (anthropometry), such as BMI, as a rationale for deciding who is morally and physically sound to pass on their genes, and who is deemed unfit or even termed as savages (which in colonizers' dictionaries, referred to individuals who are lower down in the evolutionary scale, closer to being an animal than human, with traits such as a large head, large penis, excess body hair, darker skin tone, etc. Thus providing the colonizers an excuse to leading the savages through a civilized lifestyle, a.k.a the colonized way).
Quetelet, upon observing several men, women and children in Europe, came to the conclusion that weight of an individual is nearly the square of their heights, giving birth to the Quetelet index.
Between the 1860s and 1980s, we see the insurance industries playing a major role in solidifying the BMI theory. The insurance companies wanted to ensure they weren't insuring bad risks. A life insurance refers to funds you pay to the company up until you die, and upon your death a certain amount of money is received by your beneficiary.
If the individual lives a long life, the insurance companies collect a lot of payments over the course of that individual's lifetime. However, if the individual were to die early, then the insurance company wouldn't be able to collect a lot of payments, and would have to pay the beneficiary the same amount. So, in order to makeup for the potential loss costs ahead of time, if someone was deemed likely to die early, then the insurance companies charged them more money.
They figured that they could make more money by insuring bad risks at high interest rates. Thus, an epidemiological study was launched to figure out what impacted individuals' mortality rates.
In 1910, insurance industry began documenting early deaths in overweight people. Furthermore, it was recorded that a higher BMI was worse for young people than those aged 45 and over.
In 1943 and 1959, the Metropolitan ideal weight"" and "desirable weight tables, making a comparison between weight and height, were published.
Very soon, these tables found their way into every doctor's office, setting a very dangerous standard for what's considered "healthy". Post the WWII, research sought a link between obesity and cardiovascular diseases, deeming that when coupled with high blood pressure and cholesterol, a heart attack was inevitable.
However, just like the Quetelet's index, the insurance companies' data only ever focused on a tiny demographic, a sample of individuals who had the funds and the legal ability to buy insurance, essentially the White, Caucasian, affluent Americans.
The insurance industry then teamed up with U.S. Public Health Services and the American Medical Association, to launch a nationwide campaign against obesity.
Ancel Keys, an American psychologist often voiced his opinions on these campaigns.
Keys in1972, whilst deriving results from his landmark seven countries study, published a paper renaming the Quetelet's index as the Body Mass Index. He acknowledged that
BMI Tables come from the insurance industry
BMI may not be a reliable source as it doesn't indicate obesity until one is further from a populational average
Quetlet never mentioned that the index predicted body fat buildup
Furthermore, this study was highly skewed as it observes 7426 healthy men from 5 countries, with no sample size for women nor including individuals from several other countries across the world.
So, apart from the insurance companies, predicting a linkage between the obesity and high BMI, the WHO followed suit in the 1980s, soon accompanied by the CDC and NIH. Every BMI chart out there is based on a small sample size which included only the whites.
Today, there have been several researches done to predict that body mass isn't the ideal predictor for diseases.
Risk factors for heart diseases are more common at lower BMIs in Black, Hispanic and Asian populations than in White people.
The BMI scale is a good predictor for population trends however, not so much to define what "healthy" is and isn't. The entire medical, insurance and political spheres are often focused on chasing the "healthy ideal", that one forgets that health varies from one individual to another.
Chasing the healthy average is like conforming to the Normal, which in essence, is subscribing to pre-colonial ideals of Normalcy, Control and zero Individuation.
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