This burden may fall disproportionately on Black Americans, Dr. Strings said, who as a group tend to have higher B.M.I.s than white Americans — especially among Black women. Yet evidence suggests that having a higher B.M.I. is not as clearly linked to earlier death in Black Americans. If doctors only focus on body mass index, Dr. Strings said, they may be more likely to blame their patients’ health issues on their B.M.I. or counsel their Black patients to lose weight.
In her own research, Dr. Strings has traced the origins of fat phobia in the Western world to the time of slavery, when Black women were “deemed to be excessively corpulent,” she said, as a way of positioning them as inferior to white women.
Dr. Strings argued that focusing on body mass index as a measure of health only distracts from the more important work of addressing the structural factors that lead to poor health, like “poverty, racism, lack of access to healthy fruits and vegetables” and environmental toxins, she said. “But instead, we just keep wanting to vilify fat people.”
If B.M.I. isn’t important to monitor for health, what is?
If you’re concerned about your weight, a more direct and relevant way to gauge potentially unhealthy body fat is to measure your waist circumference, Dr. Manson said. This estimates abdominal fat, which lies deep within the abdomen and accumulates around vital organs. In excess, it can increase the risk of certain obesity-related conditions like Type 2 diabetes, high blood pressure and coronary artery disease. It is also more harmful than subcutaneous fat — the soft fat you can pinch with your fingers that lies in a layer just beneath the skin.
But in Dr. Freedhoff’s weight management clinic, he and his team don’t set patient goals around B.M.I., weight or waist circumference at all. “We discuss something we call ‘best weight,’ which is whatever weight a person reaches when they’re living the healthiest life they can actually enjoy,” he said. If a patient’s weight is negatively affecting their health or quality of life, Dr. Freedhoff and his colleagues will explore weight loss strategies including lifestyle changes, medication or, in some cases, surgery. But if it’s not, Dr. Freedhoff tells patients that they may already be at their healthy weight, regardless of their B.M.I.
Rather than focusing on body size as a gauge of health, Dr. Tomiyama said that your blood glucose, triglyceride and blood pressure results can be better windows into your well-being. How you feel in your body is important, too, she said. “Can you go up a flight of stairs and feel good about how you feel after that? How are you able to live your life in the body that you have?” she said.
If you’re seeking better health, prioritize behaviors that are more within your control than your body mass index, Dr. Tomiyama said, like “better sleep, more exercise, getting a handle on stress and eating more fruits and vegetables.”