The Troubled History of BMI: Race, Medicine, and the Lasting Harms of a Misused Metric

Health standards need nuanced measures that respect every body’s unique characteristics.

By Sneha Tete, Integrated MA, Certified Relationship Coach

Created on Sep 22, 2025

Health standards need nuanced measures that respect every body’s unique characteristics.

The Complicated Legacy of BMI in Medicine and Society

For decades, the Body Mass Index (BMI) has been a fixture in doctor’s offices and health studies, touted as an objective measure of individual health and fatness. But growing evidence—and the insights of scholars and advocates—show that BMI’s widespread use is both scientifically flawed and deeply embedded in a history of racial bias and body shaming. Today, many are calling for a total rethink of BMI’s role in medicine.

What Is BMI and Why Was It Invented?

BMI is a very simple calculation: it divides a person’s weight in kilograms by their height in meters squared. The resulting number supposedly tells you if a person is underweight, ‘normal,’ overweight, or obese. Most adults have had their BMI calculated at some point, with results often shaping everything from health coverage to how doctors treat them.

If you find yourself questioning traditional health metrics, you may want to read our insightful article on whether being overweight can coexist with good health. It challenges prevailing narratives and offers a new perspective on body positivity, embracing a more holistic view of fitness.

Created in the 1830s by Belgian mathematician Adolphe Quetelet, not as a health measure but as part of his quest to define the “average man” in population studies.
Never intended as an indicator of individual health. Quetelet’s ‘Quetelet Index’ was a tool of statistical measurement—not medical guidance.

The Shift: From Population Statistic to Health Standard

Despite Quetelet’s intent, the BMI was co-opted by doctors and insurance companies in the 20th century, especially in the United States.

By the early 1900s, health insurance companies started using body weight as a predictor of health risks, setting the stage for using simple weight-to-height ratios to deny or increase insurance rates.
This evolved into the “medico-actuarial tables,” tools for insurance companies and physicians to quickly label who was ‘overweight.’

To further understand the societal implications of BMI, delve into our exploration of diet culture and its burdens. This piece highlights how societal expectations can warp our views on body image and health, offering a critical lens on the stigma people face.

Eventually, these crude tables were replaced with BMI, culminating in its official adoption by health authorities and the World Health Organization in the 1980s and 1990s.

How BMI Became Embedded in Fat Phobia and Racial Bias

To understand why critics call BMI a “racist” and “problematic” metric, we must examine the social context of its adoption. BMI was calibrated overwhelmingly on data from white, European populations, and its very categories reflect aesthetic and moral judgments rooted in white Western ideals rather than universal standards.

To comprehend the roots of fat phobia and its impact, consider checking out our in-depth analysis on understanding fat phobia and its societal effects. This discussion sheds light on the stereotypes that persist and offers insights into how we can dismantle harmful narratives.

BMI’s original studies and standards largely excluded nonwhite populations and women, yet have been applied globally and universally.
Fatness was (and often still is) pathologized far more harshly in women and communities of color, tracing back to the era of eugenics and racist health narratives.
The notion that higher body fat was inherently dangerous came from deeply flawed assumptions, conflating body size with moral worth and racial quality.

Table: BMI Categories and Stated Health Risks

BMI Range	Category	Associated Medical Label
Below 18.5	Underweight	“Health risk” (malnutrition)
18.5 – 24.9	Normal weight	“Healthy”
25.0 – 29.9	Overweight	“Health risk”
30.0 and over	Obese	“High health risk”

Note: These categories were devised without accounting for ethnic, gender, or age differences in body composition.

Curious about the fat acceptance movement? Explore our comprehensive guide on celebrating body diversity. This resource delves into ways we can challenge societal norms and promote acceptance for all body types, fostering a healthier dialogue around body image.

How BMI Fails in Medicine and Causes Real Harm

BMI does not account for factors like muscle mass, bone density, age, sex, or ethnic background. For example, an athlete could be labeled ‘overweight’ while being extremely healthy, and some Asian individuals may develop health conditions at lower BMIs than the so-called ‘healthy’ range.
For Black women and men, BMI is even less reliable: research shows that at the same BMI, body composition and health risks can vary significantly compared to white populations.
This results in misdiagnosis, stigmatization, and denial of appropriate care—especially for women and people of color.

Moreover, BMI has been used to deny life-saving treatments (such as fertility care or surgery), increased insurance premiums, and reinforce fat-shaming in the healthcare system.

To gain a deeper understanding of the biases in health care, read our exploration of thin privilege and its impact on health decisions. This article highlights how societal bias can influence medical treatment and calls for a more equitable approach to health care.

BMI and the Eugenic, Racist History of Fatness

The roots of BMI’s flaws go deeper than statistics. As historian Sabrina Strings has shown, anti-fat bias in medicine is entangled with racist beliefs. In the 19th and 20th centuries, pseudoscientific eugenics linked fatness to ‘inferior’ races and promoted thinness as the ideal—especially for white women. These associations persist in subconscious bias among healthcare providers, even today.

Medical studies that shaped BMI’s ‘healthy’ and ‘unhealthy’ ranges purposefully excluded nonwhite bodies. When BMI tables were drawn up, assumptions about ideal ‘white’ bodies drove definitions of ‘overweight’ and ‘obese.’
BMI continues to police bodies that don’t fit narrow Western standards, perpetuating bias and mislabeling countless individuals as unhealthy.

If you’re looking to understand the nuances of health obsession, check out our article on when weight loss becomes problematic, discussing how societal pressure can lead to harmful behaviors and perceptions regarding health and body image.

The Medical Backlash: Change Is Underway

Critical voices have grown louder in recent years—among researchers, doctors, and patients alike—challenging the continued use of BMI in medical practice.

The American Medical Association (AMA) recently adopted new policy explicitly recognizing BMI’s racist and harmful history. The AMA states that BMI was “based primarily on data collected from white populations” and should not be used as the sole measure of health or obesity risk.
The AMA’s policy urges doctors to use other measures and to educate themselves on the limits of BMI, including alternatives like body composition analysis, waist circumference, and genetic and metabolic factors.

Physicians are also encouraged to understand how BMI’s use upholds systemic bias and to resist denying insurance, care, or medical opportunities based on this single metric.

Alternative Health Measures Beyond BMI

Body composition scans that can distinguish muscle, fat, and bone.
Waist circumference to measure abdominal fat—linked to heart disease risk.
Visceral fat measurement (fat surrounding vital organs).
Blood pressure, cholesterol, and other metabolic markers.
Consideration of age, gender, ethnicity, family history, and genetics.

Relying on a more nuanced set of health assessments reduces bias and the risk of stigmatizing those whose bodies do not fit narrow definitions.

Why Weight Bias and the Myth of the ‘Healthy Weight’ Remain So Persistent

Even as the science undermines BMI’s credibility, its legacy endures. Many Americans, shaped by decades of public health messaging, continue to equate low BMI with health and moral value, and high BMI with disease and personal failure. The history of fatphobia, especially as it intersects with racism and sexism, stubbornly persists in healthcare, education, and the media.

Fatness is still falsely equated with poor self-control and ill health.
Communities of color continue to face harsher judgment, reduced access, and poorer treatment in healthcare settings when their BMI is higher than standardized norms.

Health advocates warn that progress will remain slow unless doctors and organizations reckon with the cultural and historical harms that BMI has promoted for so long.

The Way Forward: Reimagining Health and Body Diversity

As the major medical organizations slowly adapt, a growing movement calls for body diversity to be recognized and accepted within medicine. Key steps include:

Retiring the use of BMI as a stand-alone diagnostic tool.
Training clinicians to recognize the legacy of BMI and its role in perpetuating bias and fatphobia.
Adopting health measures that are tailored, evidence-based, and free from biased assumptions.
Centering patient dignity, autonomy, and racial/gender equity in all care decisions.

Frequently Asked Questions (FAQs)

Q: Was BMI always intended to measure health?

A: No, BMI was created by a mathematician as a way to calculate average body sizes, not as a health tool. Its adoption as a health metric came much later, driven by insurance and societal bias, not by scientific evidence.

Q: Why is BMI still used if it is so flawed?

A: BMI persists because it is simple and inexpensive, and because systems—insurance, clinics, public health campaigns—have relied on it for decades. Only now are organizations moving toward alternatives after recognizing its discriminatory and scientific limitations.

Q: Are there groups for whom BMI is especially inaccurate?

A: Yes. BMI is especially problematic for athletes, older adults, and people from non-white backgrounds, especially Black, Indigenous, and Asian populations. It fails to account for differences in body composition, bone density, and fat distribution.

Q: What health metrics can replace BMI?

A: Alternatives include body composition assessment, waist measurements, assessments of visceral fat, and considering metabolic and hereditary factors. Doctors are now advised to use a combination of these for better accuracy and fairness.

Q: How can the medical field undo the harms of BMI?

A: By listening to patients, centering marginalized voices, providing bias training, and advocating for more nuanced and personalized health standards, medicine can begin to move beyond the legacy of BMI and address the structural inequities it has helped perpetuate.

References

Author

Sneha TeteBeauty & Lifestyle Writer

Sneha is a relationships and lifestyle writer with a strong foundation in applied linguistics and certified training in relationship coaching. She brings over five years of writing experience to thebridalbox, crafting thoughtful, research-driven content that empowers readers to build healthier relationships, boost emotional well-being, and embrace holistic living.

Read full bio of Sneha Tete