Black, Indigenous and People of Colour, Larger Bodies and Eating Disorder Recovery 3
Body Mass Index (Yet Again)
“In our opinion, BMI was, and is, intended to be a statistical quantity. As such, it describes populations and not specific individuals.”
In reality that statement is not just an opinion, it’s the very foundation of statistics and its uses.
Body Mass Index, BMI, is a calculation of weight over height squared designed by a Belgian mathematician in the 1800s. It is the bane of our modern world as it has been co-opted into the medical industrial complex and it supercharges both fattism and healthism.
It is a population-based data point of incidence that means we have taken the highest rate of incidence and assigned that peak as average. However, we don’t use BMI the way it was designed to be used—just an expression of incidence across a population. Firstly, we conflate a population average with individual optimization. Secondly, thanks to the 1998 National Institutes of Health’s Panel on Obesity, the panel members decided to define 65% of the population as overweight and obese. That is, mathematically, an impossibility. The average sits at 50%, and not 35%. I have discussed in more depth the misapplication of using BMI as a causative agent in the expression or maintenance of health status for people in both Lies of BMI and Fat: Part Seven.
Black, Hispanic and Indigenous (native American) communities have higher BMI on average when compared to white and Asian communities.[2] That statement will trigger most of us making our usual judgments and assumptions on why this is the case: it’s food insecurity, food deserts/lack of food quality/variety, different beauty aesthetics, greater exposure to environmental obesogens/toxins of all kinds and differences in bone/fat/muscle ratios. Every one of those assumptions does have a role to play on these populations as a whole, it’s true.
However, it’s exceedingly difficult for us to separate correlations that are relevant on a population-wide basis and not apply them to individuals. You don’t have a BMI. As an individual, the calculation you use to arrive at a BMI is only something that is meant to be plotted on a graph with the population as a whole. But because you can calculate it, you think it’s your BMI. I get it. Your body certainly has a mass, but the index is a system of comparison. And your body mass confirms there is a force, called gravity, acting on your physical frame. Your body mass calculation done in space would be zero.
What these averages do contribute to is the reality that it’s statistically more likely that someone who is Black, Hispanic and/or Indigenous would not self-identify, or be screened for, an eating disorder. They will also be less likely to be identified as needing screening by any healthcare professional as well.
BIPoC Diagnosis Discrimination
Much of the literature on eating disorders for BIPoC communities is narrative, exploratory and rooted in social sciences investigations. That lens is important for imparting lived experiences and initiating discussions on increasing awareness in the hopes it might lower discrimination and increase timely diagnoses and appropriate treatments.
Unfortunately, these social sciences studies primarily preach to the choir—those already keen to improve their practice, address their implicit biases, and support marginalized patients in ways that truly help them, seek out these studies. Yet human resources initiatives and training attempting to improve the overall poor standards of timely diagnosis and treatment for marginalized BIPoC communities have almost nothing to show for the effort.
Where this leaves us in the so-called hard sciences, is simply study after study confirming that the rates of eating disorders in BIPoC communities are at, or even above, those found in white communities.
The following study specifically looked at eating pathology in poorer communities of colour:
“What we found was high rates of body dissatisfaction and high incidence of eating pathology, especially high frequencies of restricting behavior which is not only comparable to the NIMH and NEDA’s data for a white population but is higher than what the current data supports for any racialized group”
We are now at least 25 years into reconfirming these rates of eating disorder prevalence for BIPoC to be equivalent to, or higher than, those in white communities. Mainstream websites and articles on BIPoC eating disorder diagnosis and treatment all state that these communities are underdiagnosed and undertreated when compared to white female counterparts with eating disorders. Let’s look at that in the next installment June 20.
Image in Synopsis: Public Domain.
Silverman MP, Lipscombe TC. Exact statistical distribution of the body mass index (BMI): analysis and experimental confirmation. Open Journal of Statistics. 2022 Jun 2;12(3):324-56.
Deurenberg P, Yap M, Van Staveren WA. Body mass index and percent body fat: a meta analysis among different ethnic groups. International journal of obesity. 1998 Dec;22(12):1164-71.
Woodland SL, Lufkin KP. Is the Incidence of Eating Pathology and Intense Body Dissatisfaction in poorer communities of color comparable to national incidence?
