Just a shower thought: do studies ever account for the difficulty fat people had accessing health insurance prior to the ACA? I hear a lot about how fat people often arrive at the doctor with a later progression of a disease because they've avoided the doctor for fear of stigma, but I don't think I've ever seen anyone point out that, until recently, a fat person may have had greater difficulty in affording healthcare.
My OBGYN used BMI to assess my health while pregnant. At 34 weeks, I’d gained enough weight to creep into the ob*se category, so I suddenly got the whole list of warnings of potential labour and delivery complications despite none of the other indicators of these things being present. I was so mad that he tried to scare me about my size: at that point of the pregnancy, the baby is mostly developed and just needs to get bigger, so the birth parent is just going to keep gaining weight. This was nearly ten years ago and I’m still salty about it; it was the first time I’d really experienced someone being fixated on the number on the scale rather any of the symptoms that I was or wasn’t presenting with.
To correct a few things, I was not a member of the 1998 committee that adopted the WHO guidelines. Quetelet did not himself suggest an index, but he did note that weight increased as the square of height. Because of this observation, the index of weight/height squared was named Quetelet's index after him. This relationship is pretty consistent across populations. BMI itself as an index is not the problem. The problem is the BMI categories, how they are named, and how they are used today. BMI itself was more or less just a way to compare the weights of people of different heights, so it was just a form of height-adjusted weight. It got repurposed much later.
I deeply apologize for the misinformation Katherine, I've corrected it above. I disagree that the index itself is not the problem, both because of its roots in a racist and otherwise problematic initial purpose (of Quetelet,) and because, even if there was a period where it was not used to medicalize and pathologize fat bodies, that has long since past and the concept itself is irredeemably linked to harming higher weight people (typically for diet industry profit.) Thus, even if at some long-past time it wasn't the problem, I would argue that it is the problem now, and one inextricable from its harmful past and present.
Thanks for correcting this. I agree that currently BMI and BMI categories are misused and often harmful, which happened almost entirely in the late 1990s. Quetelet didn't even invent an index, and the weight-height relation was such a minor issue that it only appears in a short footnote in his voluminous book. I think his purpose was just to see how weight increased with height.
I apologize for taking so long to get back to you on this. I don't think we disagree on the facts, I think may be looking at them differently.
To me, the fact that Keys chose to pull the idea for the index from Quetelet's deeply problematic work (creating a standard based on cis-white European men by which, in his own words "everything differing from his proportion or condition, would constitute deformity or disease ... or monstrosity.”) matters. It is part of a history of harm that has been done to fat people, disproportionately impacting fat people of color by the BMI. I don't think that any previous concept of the index can be extricated from the modern usage and the harm it has, and continues to, perpetuate.
Thank you for this post and all your posts!!! Because of this I just did something I've been wanting to do for a while and requested that "Morbid obesity" be removed from my "health issues". To have it removed the online chart askes why it isn't relevant and I used this post (sorry for my plagiarism) to say: "This is based on my BMI, which was created by the statistician Quetelet in the 1830’s. Quetelet wasn’t trying to create a measurement for individual health and almost his entire sample consisted of European cis white men. BMI and this "health issue" of "Morbid obesity" is used to pathologize bodies based on their size, despite the fact that two people with the same BMI can have vastly different health statuses, and two people with vastly different BMIs can have the exact same health status. Furthermore, as my other health indicators suggest there is nothing "morbid" about my health (other than like everyone else we are aging, but I don't see any "morbid ageing" health issues listed). Given that people of all sizes get the same health issues, we don’t need weight, size, or a ratio of weight and height, to be a middleman for health and I reject using it in my chart. I'm happy for my doctor and I to focus on actual indicators of health rather than this poor proxy."
My doctor has denied my breast reduction, even though I have a history of neck and shoulder pain, because my BMI is 30 which nudges me into the ob#se category. She said I need to lose 10 pounds before I can have the surgery. Ten. Pounds. Most people say, lose the weight. What's the big deal? The big deal is I've been practicing HAES since 2020 and have found a wonder freedom from food obsession and binging and I can't go back. It's just RIDICULOUS! I'm currently working on a letter to my doctor delineating all the reasons why, including the ludicrous BMI.
Just a shower thought: do studies ever account for the difficulty fat people had accessing health insurance prior to the ACA? I hear a lot about how fat people often arrive at the doctor with a later progression of a disease because they've avoided the doctor for fear of stigma, but I don't think I've ever seen anyone point out that, until recently, a fat person may have had greater difficulty in affording healthcare.
We are in mind meld! This is something I'm actually working on a piece about!
My OBGYN used BMI to assess my health while pregnant. At 34 weeks, I’d gained enough weight to creep into the ob*se category, so I suddenly got the whole list of warnings of potential labour and delivery complications despite none of the other indicators of these things being present. I was so mad that he tried to scare me about my size: at that point of the pregnancy, the baby is mostly developed and just needs to get bigger, so the birth parent is just going to keep gaining weight. This was nearly ten years ago and I’m still salty about it; it was the first time I’d really experienced someone being fixated on the number on the scale rather any of the symptoms that I was or wasn’t presenting with.
"The calculation is weight (in pounds,) multiplied by height (in inches) squared, times 703."
I think you mean weight in pounds DIVIDED BY height in inches . . . ?
You are 100% right, I kept changing the way I wanted to represent the math and I ended up with it wrong. I apologize!
To correct a few things, I was not a member of the 1998 committee that adopted the WHO guidelines. Quetelet did not himself suggest an index, but he did note that weight increased as the square of height. Because of this observation, the index of weight/height squared was named Quetelet's index after him. This relationship is pretty consistent across populations. BMI itself as an index is not the problem. The problem is the BMI categories, how they are named, and how they are used today. BMI itself was more or less just a way to compare the weights of people of different heights, so it was just a form of height-adjusted weight. It got repurposed much later.
I deeply apologize for the misinformation Katherine, I've corrected it above. I disagree that the index itself is not the problem, both because of its roots in a racist and otherwise problematic initial purpose (of Quetelet,) and because, even if there was a period where it was not used to medicalize and pathologize fat bodies, that has long since past and the concept itself is irredeemably linked to harming higher weight people (typically for diet industry profit.) Thus, even if at some long-past time it wasn't the problem, I would argue that it is the problem now, and one inextricable from its harmful past and present.
Thanks for correcting this. I agree that currently BMI and BMI categories are misused and often harmful, which happened almost entirely in the late 1990s. Quetelet didn't even invent an index, and the weight-height relation was such a minor issue that it only appears in a short footnote in his voluminous book. I think his purpose was just to see how weight increased with height.
I apologize for taking so long to get back to you on this. I don't think we disagree on the facts, I think may be looking at them differently.
To me, the fact that Keys chose to pull the idea for the index from Quetelet's deeply problematic work (creating a standard based on cis-white European men by which, in his own words "everything differing from his proportion or condition, would constitute deformity or disease ... or monstrosity.”) matters. It is part of a history of harm that has been done to fat people, disproportionately impacting fat people of color by the BMI. I don't think that any previous concept of the index can be extricated from the modern usage and the harm it has, and continues to, perpetuate.
Thank you for this post and all your posts!!! Because of this I just did something I've been wanting to do for a while and requested that "Morbid obesity" be removed from my "health issues". To have it removed the online chart askes why it isn't relevant and I used this post (sorry for my plagiarism) to say: "This is based on my BMI, which was created by the statistician Quetelet in the 1830’s. Quetelet wasn’t trying to create a measurement for individual health and almost his entire sample consisted of European cis white men. BMI and this "health issue" of "Morbid obesity" is used to pathologize bodies based on their size, despite the fact that two people with the same BMI can have vastly different health statuses, and two people with vastly different BMIs can have the exact same health status. Furthermore, as my other health indicators suggest there is nothing "morbid" about my health (other than like everyone else we are aging, but I don't see any "morbid ageing" health issues listed). Given that people of all sizes get the same health issues, we don’t need weight, size, or a ratio of weight and height, to be a middleman for health and I reject using it in my chart. I'm happy for my doctor and I to focus on actual indicators of health rather than this poor proxy."
My doctor has denied my breast reduction, even though I have a history of neck and shoulder pain, because my BMI is 30 which nudges me into the ob#se category. She said I need to lose 10 pounds before I can have the surgery. Ten. Pounds. Most people say, lose the weight. What's the big deal? The big deal is I've been practicing HAES since 2020 and have found a wonder freedom from food obsession and binging and I can't go back. It's just RIDICULOUS! I'm currently working on a letter to my doctor delineating all the reasons why, including the ludicrous BMI.
This is ridiculous.. If it's helpful, I have a piece about fighting these denials here:
https://weightandhealthcare.substack.com/p/bmi-limits-healthcare-held-hostage
And some of the research for gender affirming care may also be helpful:
https://weightandhealthcare.substack.com/p/resources-to-fight-bmi-based-denials
Let me know if there is anything I can do, sorry you are going through this.