Body mass index is just a number: Conflating riskiness and unhealthiness in discourse on body size

Abstract

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.

Weight stigma in the COVID-19 pandemic: a scoping review

“…As for the characteristics of the studies, the majority corresponded to text and opinion documents (n = 16) [ 2 – 5 , 25 – 27 , 29 , 31 , 33 , 36 , 37 , 41 , 42 , 50 , 52 ] and narrative reviews (n = 6) [ 6 , 15 , 28 , 30 , 35 , 46 ]. Quantitative ( n = 6) [ 24 , 26 , 32 , 38 , 39 , 43 , 47 – 49 ] and qualitative research studies ( n = 8) [ 21 – 23 , 34 , 40 , 44 , 45 , 51 ] were retained.…”

“…Nevertheless, the predominant term was weight stigma ( n = 18) [ 2 , 3 , 5 , 6 , 15 , 25 – 27 , 30 – 39 , 43 , 44 , 47 , 52 ]. Similarly, most documents addressed more than one dimension of the concept, highlighting a higher frequency in the category of structural weight stigma ( n = 25) [ 2 – 6 , 15 , 21 – 23 , 25 , 29 – 31 , 33 , 36 , 37 , 39 – 42 , 44 – 46 , 50 , 52 ], comprising publications about stigmatizing messages disseminated in the media ( n = 18) [ 2 – 4 , 6 , 15 , 21 , 23 , 27 , 30 , 31 , 35 , 37 , 39 , 40 , 42 , 44 , 45 , 52 ], public health campaigns ( n = 5) [ 22 , 27 , 33 , 41 , 50 ] and healthcare ( n = 13) [ 1 , 2 , 4 , 5 , 15 , 25 , 29 – 31 , 36 , 37 , 42 ...…”

“…The stigmatizing content on social media during the pandemic was mentioned in seven opinion texts [ 3 , 4 , 27 , 31 , 37 , 42 , 52 ], four narrative reviews [ 6 , 15 , 30 , 35 ], two qualitative content analysis studies [ 40 , 44 ] and one quantitative paper [ 39 ]. The studies characterized weight stigma on social media as the spread of anti-fat memes and images [ 3 , 15 , 31 , 40 ] and messages [ 6 , 37 , 42 , 44 ] that mocked people with overweight [ 27 , 30 ] through jokes about weight gain, sedentary behaviour or overeating during the pandemic [ 6 , 39 , 52 ].…”

“…Eight sources of evidence of text and opinion documents [ 2 , 4 , 5 , 29 , 31 , 36 , 37 , 42 ] and five narrative reviews [ 15 , 25 , 30 , 35 , 46 ] mentioned associations to weight stigma in healthcare settings in the COVID-19 pandemic. In addition, at least one dimension of weight stigma, such as experiences of stigma and weight bias, intersections of vulnerabilities during the pandemic, high stigma or perceived vulnerability in the pandemic, or systematic weight bias, was related to consequences for people with obesity in the health sector during the pandemic, such as the impediment or delay in accessing healthcare [ 2 , 4 , 5 , 15 , 27 , 29 , 31 , 36 , 37 , 46 ].…”

“…Twenty-five included studies reported weight stigma consequences in the pandemic: six quantitative studies [ 24 , 26 , 32 , 38 , 39 , 43 , 47 – 49 ], one qualitative paper [ 34 ], six narrative reviews [ 6 , 15 , 28 , 30 , 35 , 46 ] and twelve text and opinion documents [ 2 , 4 , 5 , 25 , 29 , 31 , 36 , 37 , 42 , 52 ].…”