BMI Was Stupid, Not Racist

The American Medical Association has found itself at the center of a familiar cycle of recriminations directed toward institutions that succumb to the pressures of wokeism.

The AMA is urging physicians to avoid using the body-mass index (BMI) as a metric to gauge healthy individual body weight, in part because it has allegedly been used for the nefarious purposes of “racist exclusion.” Conservatives, who are understandably sensitive to the linguistic tics that serve only to broadcast institutional affinities for programmatic social justice, have criticized the move. And to some extent, the AMA, like so much of the American medical establishment, deserves all the grief they’re getting. This association long ago subordinated scientific rigor to the pop psychology that accompanies modern left-wing identity-focused activism — and you don’t need to be a conservative to recognize that.

But in this case, focusing on the AMA’s use of trite linguistic tropes misses the point. The logic that led the organization to scrap the BMI is perfectly reasonable, and scuttling this absurd metric is long overdue:

Due to significant limitations associated with the widespread use of BMI in clinical settings, the AMA suggests that it be used in conjunction with other valid measures of risk such as, but not limited to, measurements of visceral fat, body adiposity index, body composition, relative fat mass, waist circumference and genetic/metabolic factors. The policy noted that BMI is significantly correlated with the amount of fat mass in the general population but loses predictability when applied on the individual level. The AMA also recognizes that relative body shape and composition differences across race/ethnic groups, sexes, genders, and age-span is essential to consider when applying BMI as a measure of adiposity and that BMI should not be used as a sole criterion to deny appropriate insurance reimbursement.

Even in the time before the ubiquitous racially obsessive paranoia that passes for enlightenment today, the BMI was a controversial and deeply flawed measurement.

The BMI was adopted by states to be applied to young people in elementary schools to assess the fitness of children despite “no solid research” and “no controlled randomized” trials to judge its accuracy (to say nothing of the weight fluctuations common among pre- and mid-pubescent children). It was used to justify crackpot pseudoscience, like this instant-classic 2008 ABC News article: “Do Obese People Aggravate Global Warming?” Your Nintendo Wii relied on it to determine whether you needed to play more Nintendo Wii. And it was notorious for being overly judgmental. It was used to ban “overly thin” models from catwalks and to brand perfectly healthy but muscular individuals “overweight.”

In short, BMI was profoundly stupid. We’ve lost the gumption required to describe something that is stupid as “stupid.” Calling something “stupid” has come to seem simplistic; such a judgment must be couched in language that conveys the authority of the appraiser, and “stupid” just sounds, well, stupid. But that’s what BMI always was.

To the extent that its application produced undesirable, racially disparate outcomes, that is just one of the many ways in which BMI has failed American society for decades. It’s about time it was thrown out. If the AMA needs to tell practitioners a story that makes them feel better about their complicity with this fraud over the years, that’s a small price to pay for the restoration of some sanity to public life.