AMA: BMI Metrics Racist; Continuing 'Gender-Affirming Care'

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An anonymous woman, 42, on the scales before her weight loss surgery. The scales stop at 19 stone, but she weighs nearly 20 stone (126kg) and is severely obese.
(Photo by Tina Stallard/Getty Images)

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The American Medical Association (AMA) — the influential lobbying group for over 270,000 physicians and medical students — published a paper denouncing utilization of Body Mass Index (BMI) metrics due to “historical harm” and “racist exclusion.”

The AMA argued that BMI, defined by the Centers for Disease Control and Prevention (CDC) as “a person’s weight in kilograms (or pounds) divided by the square of height in meters (or feet)”, does not directly assess body fat, and is an inadequate measure due to the lack of consideration for variables like ‘comorbidities, lifestyle issues, gender, ethnicities… and the expected accumulation of fat with aging.’ In addition to BMI, the AMA has committed to protect “gender-affirming care” for transgender individuals.

The AMA paper, titled “Use of BMI alone is an imperfect clinical measure,” stressed that BMI fails to capture the complexities of health, especially in relation to eating disorders. As per the AMA Council on Science and Public Health report: “The use of BMI is problematic when used to diagnose and treat individuals with eating disorders because it does not capture the full range of abnormal eating disorders.”

The AMA House of Delegates has now adopted a policy recognizing BMI’s historical harm, including its use for “racist exclusion”.

Business news website Quartz supported this position, suggesting that BMI is “inherently racist and sexist,” as it was originally developed using data from European white men. The metric was popularized in the 1970s by Ancel Keys, a physiologist and nutritionist.

The AMA has also affirmed its commitment to “gender-affirming care,” opposing any criminal and legal penalties against transgender and gender-diverse individuals seeking this type of care, their family members, guardians, and healthcare providers. They passed the Endocrine Society’s resolution to protect access to evidence-based care, noting that it is the medical community’s responsibility to offer such care.

The AMA proclaimed: “In the resolution, the AMA committed to opposing any criminal and legal penalties against patients seeking gender-affirming care… and health care facilities and clinicians who provide gender-affirming care… The AMA will work at the federal and state level with legislators and regulators to oppose such policies and collaborate with other organizations to educate the Federation of State Medical Boards about the importance of gender-affirming care.”

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