Recent work in medical sociology has provided critical insights into distinguishing between obesity as a condition with severe individual- and population-level health consequences, and obesity as a socially undesirable, stigmatizing construct opposing thinness as the healthy ideal. Less often considered is the role of Body Mass Index (BMI) as the standard by which obesity and healthy weight are measured and defined. Addressing this issue, I begin by distinguishing between BMI as an empirical, objective measure of health, and BMI as an arbitrary, subjective label for categorizing the population. I further consider how BMI is empowered as a measurable quantity through the lens of medicalization and evidence-based medicine, and introduce the “performativity” of BMI as a superior framework for confronting the measure’s conceptual limitations. Emphasizing key parallels between BMI and self-rated health as measures with high predictive validity, yet unspecified mechanisms of action, I propose an epistemological shift away from classifying BMI as a biomarker and toward a more flexible view of the measure as a holistic appraisal of health. In closing, I argue that researchers may continue to leverage BMI’s ease of collection and interpretation, provided they are attuned to its definitional ambiguity across diverse research methods and contexts.

Despite the ubiquity of the body mass index (BMI) in discourse on health, there is ambiguity in its use as a biomarker of current abnormality versus future risk. This distinction is consequential for knowledge of the relationship between body size and health, as well as for individuals deemed to have abnormal and ‘unhealthy’ bodies. Consequently, the purposes of this review are threefold. The first is to differentiate this ‘biomarker’ perspective from extant critiques of BMI as a proxy for health behaviours or as the defining characteristic of obesity as a disease. The second is to highlight the shift towards treating BMI as a measure of attained unhealthiness, rather than a probabilistic indicator of risk. Finally, rather than call for the abolition of BMI, this paper argues that its continued use as ‘just a number’ is in keeping with the push for weight neutrality in research and practice. The review concludes by demonstrating how the riskiness and unhealthiness of body size is conflated in public health messaging on COVID‐19. BMI is a marker of risk, but its use as a surrogate for COVID‐19 severity equates body size with health, shaping beliefs about vulnerability and personal responsibility amid an ongoing pandemic.

Despite decades of progress, the future of life expectancy in the United States is uncertain due to widening socioeconomic disparities in mortality, continued disparities in mortality across racial/ethnic groups, and an increase in extrinsic causes of death. These trends prompt us to scrutinize life expectancy in a high-income but enormously unequal society like the United States, where social factors determine who is most able to maximize their biological lifespan. After reviewing evidence for biodemographic perspectives on life expectancy, the uneven diffusion of health-enhancing innovations throughout the population, and the changing nature of threats to population health, we argue that sociology is optimally positioned to lead discourse on the future of life expectancy. Given recent trends, sociologists should emphasize the importance of the social determinants of life expectancy, redirecting research focus away from extending extreme longevity and toward research on social inequality with the goal of improving population health for all. Expected final online publication date for the Annual Review of Sociology, Volume 47 is July 2021. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.

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Recent deaths of despair literature hypothesizes that financial losses are a key mechanism through which education is associated with higher risk for drug use, alcohol abuse, and suicidal ideation. However, few studies have empirically assessed the significance of this harmful pathway or compared it to other hypothesized explanations. Drawing on data from over 8000 respondents in the National Longitudinal Study of Adolescent to Adult Health, this paper finds that lower education-levels are associated with heightened risk of drug use, painkiller use, frequent binge drinking, and suicidal ideation; in turn, decompositions reveal that financial losses mediate about 20 percent of the association between education with drug use and suicidal ideation. The results support a core assumption of the deaths of despair hypothesis—that financial losses among those with low education-levels drive the increase in harmful despair-associated behaviors, which often precede disease and mortality. Future research should extend this work by linking individual-level socioeconomic and health patterns with broader economic changes to better understand how individuals’ educational attainment interacts with macro-level structural factors to shape their vulnerability to despair-associated disease and death.