The connection between Black female bodies and ill health, fatness, and inferiority marks the historical record on race and health. The Body Mass Index (BMI) is a prominent contemporary marker of this linkage. While there are strong arguments for and against the contention that there is a causal connection between BMI and ideal health, these often leave out how race intersects with structural inequalities and fictitious genetic propositions. Many variables work to produce the persistent belief that racial categories are rooted in genetics, that BMI is an adequate measure of “good health,” and that there is a racial-genetic component to how bodies look.
But first let’s define our terms — starting with BMI. The Body Mass Index is measured by a simple, some might say too simple, equation first used 200-ish years ago (its Belgian inventor was a noted eugenicist): weight divided by a person’s height squared. A BMI of 30 and above places you in the obese category, while 25 to 29.9 categorizes you as overweight. Doctors, insurance companies, scientists, and policy makers use it as a gage to evaluate an individual’s relative health. Health advice, public programs, and prescriptions are still doled out based, to a significant degree, on BMI.
And yet the criticisms of BMI are manifold. First, BMI was never intended to ascertain the health status of individuals, only to generalize about population averages. BMI also does not account for differences in muscle mass, bone density, or fat distribution (e.g. waist size), which makes it an imprecise tool for diagnosing overall health status. Moreover, on the level of methods, when we pick apart demographics, we find that the data that defines a “normal weight” reflects gender bias since it is based on the measurements of the “average” man.
When it comes to race and health, however, things become even knottier. To be clear, there is no race gene, and thus phenotypical (appearance-based) differences between individuals are just that — superficial differences that have no connection to intelligence, capabilities, behaviors, or beliefs. In fact, there are often more genetic differences between individuals of the same racialized group than between groups themselves.
In light of this, BMI cannot and should not be racialized. Since size and body fat distribution have no racial-genetic correlates, the only way to talk about BMI and race is in terms of how structures of inequality have led to differential health outcomes. A discursive sleight of hand that places blame on genes rather than structural health inequalities emerging from food deserts and inadequate health care allows the belief that ill health is genetic, not structural, to continue.
Recently, however, more general criticisms of BMI have expanded to include its failure to account for racialized bodies (since BMI is based on the average white male body). Intuitively, the call for diversity in research is a perfectly reasonable demand. Given the historical exclusion and exploitation of raced communities, a mandate to address injustices at the front and back end of health models seems both sound and ethical. Newsweek made a similar call in a recent piece titled, “There’s a Dangerous Racial Bias in the Body Mass Index.” However, conducting research in this way seems to support that racial differences cause differential health outcomes, when we know that they are the product of a lack of access to sustainable and healthy food as well high rates of poverty, stress, and pollution that cleave along racial lines.
I have to ask — why do we insist on holding tight to racial categories and outmoded barometers for monitoring health? It is not that BMI fails to account for body types based on race that is the problem; rather, it is the material impact racialization has on health outcomes. While the rationale for the inclusion of BIPOC (Black, Indigenous, and People of Color) groups in science as necessary for the purposes of diversity seems obvious, making this argument risks reifying race as a biological fact. What we should be talking about is how and why we continue to conjure race and racial distinctions, what the material impacts of continuing to do so are, and endure in our critique of BMI as a problematic gauge for everyone’s health.
The history of racialized science can help us understand how race figures in our current understanding of health. The scientific racism of the 19th century produced a kind of “common sense” wherein Europeans were considered to be the more evolved and intelligent race. This, coupled with Social Darwinism, as Tayyub Mahmud argues, made race the cipher for whether or not a group is evolved based on anatomical studies that place races in a hierarchy of “civilized” and “not civilized.”
When it comes to BMI, race, genes, and non-normative bodies, the story of Sarah Baartman is illustrative. Sarah Baartman (often referred to as the Hottentot Venus) was a Black enslaved woman from South Africa who, because of her large body and her unusual behind, was taken around Europe and the US and put on public display as a symbol of the hypersexual Other — an oddity who was evidence of “what many believed proved racial scientific claims of African barbarity.” Baartman, exploited for years by European scientists and academics, is emblematic of the non-normative and unruly Black body. The body itself is pathologized and seen as dangerously distinct from white bodies. The sedimentation of this view feeds into the seemingly principled call for BMI to include the measurements of BIPOC men and women. And yet, doing so risks accomplishing the opposite of what is intended — namely to reveal race for what it is, an arbitrary mode of phenotypically categorizing people in a hierarchical structure.
I suspect that BMI is not the only method of categorization we continue to use that contains these kinds of contradictions. So we need to set priorities. This includes a robust discussion of how science perpetuates the categorization of people into discrete races and how calls for diversity in science can have unintended consequences. Doing so requires that we highlight the importance of dismantling harmful racial stereotypes. This will allow marginalized communities to retain cultural and community solidarities based on race. It is important to unravel these threads carefully, pay attention to how they are co-constituted, and avoid getting caught up in binary modes of thought that do not serve the objectives of health or wellbeing.