Fatphobia is racist and the BMI is racist, sexist, transphobic trash
A peak from my upcoming book Unfuck Your Body
Keep in mind my editors haven’t gotten their mitts on this chapter yet, so excuse that it’s rough. But this issue has been coming up ALOT lately so I wanted to share these sections from my chapter on food with y’all. Okthxbai.
Skinny Doesn’t Equal Healthy (SAY IT OUT LOUD FOR THE PEOPLE IN THE BAAAAAACK)
Fatphobia Is Racist
Centuries ago in Europe, being full figured was synonymous with being healthy and strong (look at Renaissance art work if you want to see the ideal). This carried over to early the early days of colonization of Turtle Island (now North and South America).
Because of availability of enough food, Americans weren’t just heartier, they were much taller than their families back in Europe. By the mid 1800s, there was an eight centimeter high discrepancy between Americans and Europeans. It was fashionable for women would drink down “weight gain” tonics if they were too skinny to catch a good husband.
The widespread trade of enslaved people was happening concomitantly, and this presented a problem. In order to mentally justify the ownership of some bodies by other bodies, there had to be a mechanism for deciding superiority and inferiority.
It was easy at first because of skin tone. But future generations if enslaved peoples became lighter and lighter. The continued rape by slave owners and interbreeding with enslaved indigenous peoples (yes that happened, too) meant lighter and lighter skin. So the comparison of body types, frame size, where fat settles on the body, etc became the mechanism for deciding who is superior (see Sabrina Strings amazing book Fearing The Black Body.)
Being hearty and strong became less and less the ideal. And frankly, wasn’t as necessary if you forced other people to do physical labor for you.
A Presbyterian minister by the name of Sylvester Graham (yes, the graham cracker guy) promoted an extremely restrictive lifestyle and diet (the original graham crackers were not yummy, trust). He died in 1851, but his followers remained active through the 1880s.
Tonics meant to put on weight became replaced with ones meant to melt it away.
Lulu Hunt Peters a young woman who had struggled with “baby fat” into adulthood, earned her MD and translated nutrition research to the public in what became a bestselling book. Diet and Health: With Key to the Calories was released in 1918 and included an extensive list of “100 calorie snacks” and restriction became the rage. But then the question became, how do we decide what determines an acceptable amount of thin?
The BMI Is Specifically Racist, Sexist, And Transphobic As Fuck
The Body Mass Index was actually invented 200 years ago. The dude who did so, Adolphe Quetelet, was not a physician, but actually an academic who was super fired up on sociology, math, and statistics. He was in Western Europe and was looking for ways to identify the characteristics of “the average man” ( l’homme moyen) thinking that represented the social ideal of manliness. A Belgian in the 1800s, he was also part of the boom in racist “science” (he is also credited with founding the field of anthropometry, which includes all that phrenology bullshit).
But anyway, he believed that the mathematical mean was the human ideal (I AM ALSO A STATISTICIAN AND CAN CONFIDENTLY SAY THAT THE MEAN OF ANY GIVEN GROUP DOES NOT AT ALL HAVE ANYTHING TO DO WITH THE IDEAL ANYTHING). Based on the measurements of French and Scottish men, he came up with a formula known as Quetelet’s Index (now known as the Body Mass Index [BMI]). By the early 1900s, this index became the mechanism for determining of someone was fit to parent...and as a justification for eugenics.
And not just against people of color, but also poor people, people with disabilities, and neurodiverse people.
Even more darkly humorous, Quetelet was perfectly content that his scale was used to force sterilization (eugenics)...he never meant it as a measure of body fat, build, or individual health.
But then, capitalism. US Life Insurance companies began compiling tables of height and weight to determine what to charge policy holders. The tables were based on the weight and height of the people who could actually afford to purchase life insurance and had the legal means to do so. And the numbers were self-reported. Most tables did not include frame size or factor in age. And all this information was put together by sales agents and actuaries, not medical professionals.
And now these tables exist. And physicians began using them as a means of evaluating a patient’s weight as an indicator of their health. This went on through the 50s and 60s, until medical science decided to find a more effective measure in the 70s. A research team led by Ancel Keys conducted a study of 7,500 men (yes, only men) from five (yes, only five) different countries trying to find the most effective measure of body fat that would be easy and cost effective for a regular PCP visit. THey compared it to the use of skin calipers and water displacement and found that all were weak but the BMI sucked the least.
The BMI diagnosed “obesity” accurately about 50% of the time. This level of “accuracy” has continued to hold at 50%...a 2011 study in the Journal of Obstetrics and Gynecology stated that yup...it was right half the time. No matter. In 1985, the National Institutes of Health redefined obesity in terms of BMI. And that made it literal public policy.
The NIH wasn’t done with us though. In 1998, they changed the definitions of both “obese” and “overweight” lowering the threshold of what is medically considered fat. All of a sudden, millions of people became medically (and legally) fat without gaining a pound. And now we can have a good old fashioned public health crisis over our obesity epidemic.
So now we have a systemic problem that dispropportionaly affects women, individuals of color, and even trans people. There are sex based differences that are not accounted for (any woman who has ever been heavy at some point in their life has a story of being told by a doctor that their chief complaint will be resolved through weight loss. Additionally, Many trans individuals are denied surgical gender confirmation interventions until they lose weight, even though an 18 year year study of post-op complications shows this is not the case. And according to the World Health Organization (WHO), the BMI overestimates fatness and health risks for Black people while underestimating the health risks for Asian communities.
People are being dismissed, underdiagnosed of a true illness, and denied life saving treatments and surgeries based on a two hundred year old tool designed to legitamize ethnic cleansing and cultural genocide.
And I don’t think the irony is lost on any of us right now.
Even A “Healthy” BMI Isn’t Necessarily Healthy
Primal blueprint guru Dr. Mark Sisson uses the term “skinnyfat” (which yes, even he recognizes as problematic) to describe the fact that you can have a low BMI and not be at all healthy. Not just if you have an illness or an eating disorder, but just some people seem to have these insane metabolisms that keep them slim yet they are not any healthier, or even far less healthy, than their thicker counterparts. A friend of mine was bluntly told by her doctor when approaching 40 “yes you are tall and slim but that doesn’t mean you aren’t rotting on the inside, you gotta take better care of yourself.”
The official term is metabolically unhealthy non-obese (MUHNO). Skinny doesn’t equate healthy. Just like in the early days of the US when scrawny was considered problematic it still is. MUHNO individuals may be eating like crap and not moving their body and are therefore still be insulin resistant, high triglycerides, high blood pressure, cardiac issues and high inflammation markers (An indicator we keep returning to again and again). Their body fat patterns are just different, not better. Minute body fat isn’t any better though. Extreme bodybuilding can also lead to metabolic shut down. I’m not dissing bodybuilding (my son is a weightlifter and it’s a huge part of his wellness routine), but it isn’t an indicator of health in and of itself.
The Mandalorians may say “this is the way” for alot of things, but that doesn’t work for bodies. Bodies are all weird and different and are their own things. Dr. Lee Kaplan, the director of the obesity, metabolism and nutrition institute at Massachusetts General Hospital, has uncovered 59 different types of obesity in humans so far and there are at least 25 different genes associated with obesity.
Sure, some are associated with health conditions. The types of body fat that wraps around our internal organs (visceral fat) is associated with metabolic syndrome, non-alcoholic fatty liver disease and the like. But we are far more likely to be successful in making improvements in these conditions by focusing on lifestyle changes (diet, movement) instead of weight loss.
And more and more medical professionals, if they do suggest a specific weightloss goal, will tie it to waist circumference (where that visceral fat will hang out, if that is indeed the type of fat that you have) instead of BMI.
Your weight set point may not change (see Linda Bacon’s fantastic book Body Respect for more on the research in this area), but you may mitigate stress on your organs.
Even if you make a weight circumference change and you eat right and you move you body now and then, this is still not the biggest predictor of your lifespan. When it comes down to it? The greatest indicator of life span is not your mass, it’s your class.
If I wanted a good test of whether or not you are in good health and will live a long life, rather than looking at your BMI, I would look at your socioeconomic status. This is true for virtually every disease in every industrialized country. And the greater the level of inequality in a country, the greater the health disparities. Your access to care changes, the respect you are given when you do access care changes, and you access to a healthy environment and nutritious food changes. The aforementioned book by Linda Bacon goes into great detail about this topic as well.
So all the changes I suggest are taking these systemic factors into account. In this chapter I want to cut through some of the info-overwhelm associated with healthy eating and follow up in upcoming chapters about supplements and movement. So we can focus on the forces we can control in the face of systemic obstacles.
…and if you are now super interested in this book, you can find it here