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On this podcast episode, Alissa Rumsey joins us to talk about Body Mass Index, the history and misconceptions of BMI along with biases and lack of healthcare associated with high BMI.
Where did the concept of BMI come from?
To talk about the history of the BMI we have to go back to the early 1800s in Europe. Originally called the quetelet index; it is the same equation that we use today, using a person’s height and weight. The quetelet index was developed by a Belgian man who was an astronomer, mathematician, and statistician. It is important to note, he was not a doctor, nor a health professional of any kind.
In developing the quetelet index he was trying to categorize populations and find the “average” man. This is important because averages measure entire populations and don’t apply to individuals. And also, what’s important, is the data that he used to create this equation, the same one that we use today, was using height and weight data primarily from white, middle to upper class Europeans, which means it’s not a representative sample of the general population.
Now, fast forward to the late 1800s, early 1900s, where life insurance companies in the U.S. were starting to use height and weight data to determine their life insurance rates. So here we start to see capitalism coming into play with this data. Also, the data that the life insurance companies were using was from white men. In the mid 1900s, the quetelet index was renamed as the body mass index or the BMI by Ancel Keys, and he was using it again in population studies.
The cutoffs that we see today as “underweight,” “normal weight,” “overweight,” and “obese,” are arbitrary cutoffs and were influenced by the life insurance tables that used data primarily from white men. So, there is a lot of racism and capitalism embedded there. This data was meant for looking at population dynamics, not individuals and not looking at health.
Why then are we still using BMI?
I think because it’s so embedded into our health and health care system, as well as insurance and insurance reimbursement. It’s about capitalism. Here in the US, our health insurance is all for profit. One example is regarding funding from pharmaceutical companies that make weight loss drugs. When task forces were looking into BMI cutoffs, the recommendations that came out were to lower that cut off of what is overweight because these pharmaceutical companies have an active interest in more people being classified as overweight, so that more people can be prescribed these weight loss drugs. There are a lot of examples of that.
I think another reason is because it’s just so embedded into everything, and it’s a simple, cheap tool. When we think of a person’s height and weight for perhaps population based research studies, that might be something that is okay to use, although I think it’s very problematic in that case. But now, we see it used on an individual basis. Someone walks into their physician’s office or gets admitted to a hospital, and immediately it is calculating their height and weight and BMI. And not only calculating it, but then making a judgment of someone being healthy or unhealthy solely based on that number. And then treatment plans and prescriptions are then decided upon solely based on that number, which is very problematic.
Sometimes when your BMI is normal you are considered fine. As in there can’t be anything else wrong with you. No, we should still be asking people more questions and looking deeper, and vice versa. If someone has a higher BMI, we should not use that as a reason you can’t have surgery, or you’re denied life insurance, or all of these things that happen all of the time to people with high BMIs. I think we really need to look at health more holistically, because right now our medical industrial complex looks at it in a very narrow lens. And that’s actually not what health is.
What are some metabolic markers that you would recommend looking at to evaluate health?
There are a lot of different things to look at instead of only BMI. Physicians will look at blood pressure, heart rate, your hemoglobin A1C, cholesterol levels. These all can be used as screening tools.
We still need to be talking to the person in front of us, because these markers are great for screening, but how is the person feeling? What are their genetic risk factors? I see this all the time. Cholesterol and diabetes is a great example of this. People come in and they have so much shame, and they are resistant to taking medication. Often they’re resistant because they feel like they caused it and that they need to fix it and they have shame about taking medication.
In our society, in our culture we think we should be able to keep ourselves healthy; we should be able to prevent all these diseases. And that’s not the case. We don’t have as much control over our health as we have been led to believe. Absolutely, there are things we can do to promote good health, but there are so many societal, environmental, and genetic impacts on our health. Individual behavior can be attributed to 30% of our health. So that means another, like 60 to 70% are things technically outside of our control. There is so much shame and so much stigma, and that prevents people from getting good health care.
I think it’s really important to know that you should not have to advocate for yourself. Unfortunately, the way our healthcare system is set up, you have to most of the time. You have to bring up these conversations with your doctors. Oftentimes people with a “normal” BMI get the actual treatment for whatever their condition is, but people with a higher BMI are told to lose weight. An example of that is I had a client with hip pain. She went to her doctor, and they told her to lose weight. I had hip pain. That same year, I went to my doctor, and I got a prescription for physical therapy, I got X rays, and I got treated for my hip pain, whereas she was just told to lose weight.
To hear Alissa talk more about BMI and advocating for your health, listen to podcast episode #168 on Vaginas, Vulva, and Vibrators.
You can find Alissa on her website, AlissaRumsey.com.
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