A few years ago I was getting a pap smear. The doctor—whom I had just met that morning—had me in those cold metal stirrups and was rooting around in my vagina when she asked, ever so casually, “so, do you know what the BMI is?”
I laughed.
As if a woman who has been fat all of her life might have never heard of the BMI.
The thing is, we all know about the BMI. It’s a simple chart that measures our height against our weight, right? The number that comes out of that equation places us into categories—underweight, normal, overweight, obese.
The BMI is supposed to be a value-neutral way to assess bodies across populations.
Except that, did you know that the BMI has never been neutral?
Adolphe Quetelet (1796-1847), a French statistician, came up with the system we know today as the Body Mass Index. But Quetelet, influenced by early 19th century astronomers (!), charted human height and weight in an effort to establish ‘normality’—not health, or anything to do with medical risk at all. Quetelet believed that by constructing “l’homme moyen,” (the ‘average man’) through his chart, one could determine at what point bodies could be identified as deviant (by the way, Quetelet was also super interested in criminology and his work influenced the super shitty and oppressive fields of phrenology and eugenics). The chart shows that variances in body size more or less fall into a bell curve.
He noted in his work that artists have long used a similar way of looking at bodies: “deviations more or less great from the mean have constituted [for artists] ugliness in body as well as vice in morals and a state of sickness with regard to the constitution”. Quetelet noted from the get-go that the BMI is not understood in neutral terms, but is instead inscribed with cultural meaning.
So, Quetelet—this genius-level polymath with zero interest in health and 100% interest in categorizing certain bodies as ‘normal’ and the rest as ‘deviant’—created this nifty chart that even he knew was not value-neutral.
Then, in the early 20th century, life insurance companies decided to adopt Quetelet’s index as an indicator of mortality. The chart was a way for them to justify charging deviants—people at either end of the bell curve—more money for insurance.
You guys, the BMI is about capitalism.
Okay so eventually the medical community caught on, and studies were conducted in order to confirm that this NOT value-neutral categorization system could at least show us that some things were true about the different categories across incredibly large populations (but not at the level of the individual).
So again, a chart that was created to measure normalcy and deviance, which was acknowledged from the beginning as not being free of bias, was adopted by one industry as a way to make money, and then another as a “neutral” predictor of health risk??
Right. Okay.
Fat studies and disability studies academics have written about the BMI—and its construction by Quetelet—at length. Disability activist and theorist Lennard Davis calls Quetelet’s index “a symbol of the tyranny of the norm”. The norm, he argues, is even far more oppressive than the ideal: whereas the ideal is understood by most to be unattainable, the norm is something to aspire to, a “hegemonic vision of what the human body should be”.
Rosemary Garland-Thomson, another disability theorist, argues that the superiority of the ‘normal’ body (white, male, able-bodied, thin, etc.) appears “natural and undisputed”.
This is important. Because of the BMI, because of work by people like Quetelet, because of the way we value bodies culturally, what we think of as normal is actually just a social construction that seems natural because it has been hammered into our heads over and over again for the last 200 years. First by artists, then by astronomy-obsessed statisticians, then by money-hungry insurance companies, and, finally, by the medical-industrial complex.
Of course, it doesn’t take all this research to know that “normal” is a fucked up oppressive concept. But it was definitely fun to see the look on the doctor’s face when, still knuckles-deep into my vagina, I told her just how much I knew about the BMI.
More like “doctor” - someone trying to shame a patient while on the exam table should have their license taken away. Do no harm my behind.