Is BMI Accurate for Everyone- Factor in Race and Gender?

Is BMI Accurate for Everyone? Let’s explore how race and gender impact Body Mass Index measurements. Why do many health experts question the one-size-fits-all approach to Body Mass Index? If so, you have landed on the right page.

Is BMI Accurate for Everyone?

Did you know that researchers estimate nearly 75 million Americans are “misclassified” as heart-healthy? This raises an important question: Is BMI accurate for everyone, or does it fail to account for important factors like race and gender? Meanwhile, more than 30 percent of people with so-called “normal” weight are actually metabolically unhealthy. 

What is BMI and Why Are People Inquiring?

The Body Mass Index (BMI) comes from a simple math formula. It was created in the 1830s by a Belgian statistician, sociologist, and mathematician named Lambert Adolphe Jacques Quetelet. But why has this nearly 200-year-old measurement tool caused so much discussion lately? Let’s explore why many health experts believe BMI might not be accurate for everyone.

Is the Body Mass Index Outdated?

In 1972, the Quetelet Index was renamed the Body Mass Index. Physiologist Ancel Keys claimed BMI was essential for measuring health on an individual level. If you think it’s strange that we still use a system from the 1800s, you’re not alone. The BMI is questioned today for several key reasons:

• It was not developed by a medical doctor
• It doesn’t consider differences between races and genders
• It fails to account for different body types
• It can’t distinguish between muscle and fat

How BMI Misclassifies People

One major criticism is that BMI cannot measure your body composition—specifically, the ratio of lean mass to fat mass. Dr. Noel Bairey Merz, director of the Cedars-Sinai Medical Center in Los Angeles, has expressed concern about the validity of BMI.

BMI Doesn’t Show Body Fat Percentage

“While BMI gives doctors a basic guess at a patient’s body mass percentage, it is in no way the complete picture when it comes to their overall health or even the amount of body fat they have.”

Comparing Apples and Oranges

Consider these examples:

• A fit 35-year-old with lean muscle mass weighs more
• A 65-year-old of the same height weighs less
• BMI shows the younger person has a high BMI, despite being healthy

This raises questions: Does BMI discriminate based on age, gender, or other factors?

Is BMI Racially and Gender Biased?

Many academic communities have found BMI to be racially biased. Medical critics argue, “You cannot use weight alone as a marker of health.” In fact, numerous study groups claim that BMI is not just inherently racist but also gender-biased.

BMI Creator’s Original Intent

It’s important to note that Quetelet should not be accused of being racist because of his creation. He didn’t intend to discriminate against anyone. Even if there is a correlation between disease and high BMI, calculations must include other factors before drawing conclusions about a person’s health. The system was created to help people, not harm them.

Does BMI Help or Harm People?

Research shows that weight loss isn’t the cure-all it’s often presented as. In fact, chronic dieting can lead to heart attack and stroke. Adele Jackson-Gibson, Senior Editor of Good Housekeeping, states: “This questions whether blanket weight loss initiatives and deep-seated fears of ‘excess’ fat are helping or harming the well-being of individuals and communities at large” (2022). She believes BMI discriminates on many levels.

How BMI Fails Different Demographics

BMI’s Inaccuracies Across Populations

• People of Asian descent have twice the risk of developing type 2 diabetes compared to white people at the same BMI
• Current BMI cutoffs are based on an “ideal” Caucasian body and don’t consider gender or ethnicity
• These narrow standards have been applied globally despite significant population differences
• In Central Africa, where white people are the minority, the same BMI standards from the U.S. are used
• China and Japan define “overweight” as a BMI of 24 (0.9 lower than the U.S. cutoff)
• Standard cutoffs don’t reflect the experiences of many families
• South Asians experience higher incidences of metabolic disorders at lower BMI levels
• Many people with higher BMIs have completely normal lab work and vital signs

BMI and Its Impact on Healthcare

People in larger bodies often receive lower quality care, and doctors may misdiagnose their symptoms. Too much focus on weight can encourage harmful emotional eating patterns and avoidance of medical care.

How BMI Impacts Different Racial Groups

Race/Ethnicity	BMI Impact	Recommended Adjustments
Asian	Higher risk of diabetes at lower BMI	Lower BMI cutoff (23 for overweight)
Black	May overestimate body fat percentage	Consider body composition, not just BMI
Hispanic	May misclassify health risk	Evaluate waist circumference alongside BMI
Pacific Islander	Often misclassified as “obese” despite good health	Consider metabolic health markers, not just BMI
White	Standard BMI scale was based primarily on this group	Standard BMI scale may be most accurate

 

How Gender Affects BMI Accuracy

Gender	BMI Impact	Alternative Considerations
Women	Typically higher body fat percentage than men at same BMI	Body fat percentage, waist-to-hip ratio
Men	May have higher muscle mass affecting BMI	Body composition analysis
Pregnant people	BMI not applicable during pregnancy	Specific pregnancy weight guidelines
Older adults	Lose muscle mass with age, affecting BMI accuracy	Adjusted BMI ranges for seniors

 

BMI Inaccuracies for Women of Color

Women of color face higher health risks for high blood pressure, diabetes, high cholesterol, and other conditions often associated with higher weight. They are also more likely to experience chronic stress, economic inequality, and institutional racism. In her book “Fearing the Black Body,” Sabrina Strings describes the discrimination that women of color in America endured during the 19th century related to body size.

How Higher BMI Promotes Discrimination

Our culture places too much emphasis on thinness and BMI. As a result, patients with high BMIs are sometimes denied treatments such as IVF or surgeries. Many people cannot get surgery until their weight falls below a certain threshold. This practice can lead to delayed or denied care.

Misdiagnosis Discourages People 

According to Dr. Paula Brochu of Nova Southeastern University, “If a person is not fat, they are much more likely to receive scans and treatment for knee pain at the time of complaint.” Being mistreated or misdiagnosed discourages heavier patients from seeking medical care. They are affected by stigma, regardless of gender. Importantly, heavier people are not necessarily less healthy than those who weigh less.

BMI Inaccurate for Metabolically Healthy People

Dr. Brochu’s study examined people’s cardiometabolic health across the BMI spectrum and found surprising results:

• Nearly half of the people classified as “overweight” and almost one-third of those classified as “obese” are metabolically healthy
• Almost one-third of people with “normal” BMIs were metabolically unhealthy
• Someone with a normal BMI might be at serious health risk, while someone with a higher BMI might be perfectly healthy

Is BMI Biased Against Certain Groups?

This oversight is deeply rooted in our history. In her research, Dr. Brochu describes how “the idea of blaming fatness for Black women’s health problems echoes 19th-century pseudoscience that claimed Black women eventually die off due to their ‘animal appetites’ and ‘unwieldy size.'” Today, Black, Indigenous, and People of Color (BIPOC) are fighting back against these harmful stereotypes.

Systemic Issues Affecting BIPOC Health

Systemic issues continue to impact the health of people of color. These disadvantages contribute to the development of chronic diseases. For example, BIPOC communities:

• Disproportionately live in food deserts
• Are more exposed to air pollution
• May have access to contaminated water

At this level of disadvantage, a BMI number further stigmatizes and does a disservice. We need effective ways to care for people without making them feel inferior.

From Criticism to Better Solutions

How reliable is the link between higher BMIs and poor health? Body fat has come to be feared as one of the greatest threats to society. According to the U.S. Department of Health and Human Services Office of Minority Health,

Black women have higher rates of being categorized as “overweight” compared to other groups in the U.S. This classification suggests they face higher risk for high cholesterol, high blood pressure, heart disease, and stroke—but the relationship is not that simple.

The Insurance Industry’s Role

Health insurance companies in the early 1900s linked “excessive” body fat with increased risk of heart disease (and many still do), even though current science suggests it’s much more complex. This was significant because insurers used this information to determine coverage.

Insurers often refused to cover people classified as “overweight,” while many doctors saw these “medico-actuarial tables” as a quick tool to decide which patients they would accept. In essence, insurance coverage and BMI created a system that disadvantaged many people.

Why is BMI Still Used Despite Its Flaws?

BMI is misleading because this estimated number doesn’t account for your race, gender, muscle mass, lifestyle, or other relevant health measurements like cholesterol or blood sugar. This raises an important question: why is BMI still used?

The main reason is that it offers a quick, simple, and inexpensive assessment of whether a person might be at a healthy weight based on an estimation of body fat percentage. It serves as an affordable starting point—but it should never be the only measure of health.

The History of Modern BMI

In 1972, obesity researcher Ancel Keys claimed his new body mass tool had more accurate tables, using data primarily from white European and American men. This study concluded that the Quetelet Index was superior to previous height and weight tables in measuring body fat. The QI was then rebranded as the BMI we know today. However, its limitations are becoming increasingly recognized.

Your Rights at the Doctor’s Office

According to the CDC (2020), 42.4 percent of American adults aged 20 and older are classified as “obese” based on BMI. However, if you don’t wish to have a BMI scan or be weighed at your next doctor’s appointment, you now have options.

If you would rather not be weighed the next time you visit your physician but aren’t sure how to say so, visit more-love.org. There, you’ll find helpful phrases to use and small cards you can give to healthcare providers to express your preference. Remember: a higher weight is not automatically a synonym for “unhealthy.”

Frequently Asked Questions

What is a Good BMI for Women?

While BMI indicates potential body fat levels, it cannot measure how fat is distributed in the body. Waist measurements and waist-to-hip ratios can provide better information about health risks than BMI alone.

What is a Good BMI for a 14-Year-Old?

BMI-for-age percentile compares your teen’s weight to that of other teens. For children and teens ages 2 to 19 years, BMI varies by age and sex. You can easily calculate it using the CDC’s online tool.

What is a Good BMI for Older Adults?

Research shows that adults over 75 often do better with a BMI between 25 and 27. Older adults who are underweight experience more health issues and shorter life expectancy than those with slightly higher BMIs.

How Accurate are BMI Calculators?

BMI is based on height and weight but does not account for muscle mass, bone density, overall body composition, or racial and gender differences. Use standard BMI measurements with caution.

When Should BMI Be Used?

The standard BMI calculation was designed for non-pregnant adults between the ages of 18 and 65. Although BMI is calculated the same way for children, the results are interpreted differently. Standard BMI calculations should not be used for those under 18 or for older adults.

What Information Do I Need to Calculate My BMI?

You need your body weight, height, and a calculator with a square function.

What is the Most Accurate Way to Measure Body Composition?

Calipers are the cheapest and easiest way to measure body fat in specific areas. Use three spots on your body—chest, abdomen, and thigh. Another option is the Dual-Energy X-ray Absorptiometry (DEXA) scan, which is the most accurate testing available.

Does Body Frame Size Affect BMI?

Yes, body frame size affects a person’s measured BMI. People with very large body frames can record BMI measurements indicating higher body fat levels than those with smaller frames, even when their actual body fat percentage might be similar.

Final Thoughts

BMI is not a one-size-fits-all calculation. Although it can identify certain patterns in population health, it doesn’t consider important factors such as a person’s economic situation, age, gender, living conditions, access to resources, and chronic health conditions that contribute to different BMI patterns across populations.

The medical community continues to improve how we measure and understand health, moving beyond simplistic numbers to more comprehensive, personalized approaches. We need better tools that serve a more meaningful purpose for individuals, communities, and society as a whole.

Thank you for sharing this BMI journey with me. I hope you found this information helpful. Please share it with people in your social circle. Also, feel free to leave your questions and concerns in the comment section below—that’s my favorite part of blogging: getting to have a dialogue with you!

Rachele, Founder
Website: mybluegenes.com
Email: rachele@mybluegenes.com

References

1. Strings, S. (2019). Fearing the Black Body: The Racial Origins of Fat Phobia.
2. Centers for Disease Control and Prevention (CDC). (2020). Adult Obesity Facts. cdc.gov
3. Strings, S., Ph.D., Associate professor at University of California, Irvine.
4. Jackson-Gibson, A., Senior Editor of Good Housekeeping. (2022).
5. Quetelet, A. A Treatise on Man and the Development of his Faculties.
6. Brochu, P., Ph.D., Nova Southeastern University.
7. U.S. Department of Health and Human Services Office of Minority Health (OHM).
8. The Racist History of the BMI – Racist Origins of Fighting Obesity. https://www.goodhousekeeping.com/health/diet-nutrition/a35047103/bmi-racist-history/