Thanks for the vaccine, but BMI is bullshit

Wisconsin and other states are relying on a measurement that has long created problems in health care.

COVID virus and protein image via National Institutes of Health, scale via pixy.org.

Tucked safely in bed, lights off, goodnights said, I pulled my iPod Touch out from behind my pillow and quickly Googled “BMI calculator.” In no time, the NIH website I’d used countless times before bounced to the top of the search results and once again I entered my information.

“5’7”” “Woman” “155” pounds. 

BMI: 24.3.

Still considered in the “normal range” but dangerously close to the number I feared more than anything—the start of the “overweight” category—25. From there, I calculated how many pounds I’d need to lose and how many calories I could eat (or more accurately, not eat) in order to get myself down to the coveted “underweight” BMI categorization of less than 18.5.  

I was about 12 years old at the time. This process carried on for years.

State officials announced Thursday that Wisconsinites 16 to 64 years old with some health conditions will be eligible for a COVID-19 vaccine starting March 29. This expanded eligibility includes those with asthma, cancer, hypertension, and other conditions based on CDC recommendations. 

Also included on the list are individuals considered overweight or obese, by body mass index definnitions. A BMI between 25-29 places you in the “overweight” category; 30-39 makes you “obese”; and 40+ is categorized as “severely obese.”

Cue the jokes about fish fry, beer, and cheese. Wisconsinites were quick to capitalize on the new expanded eligibility as a chance to once again caricature themselves as alcohol-guzzling dairy lovers who could easily gain a few pounds by attending a fish fry or two. The jokes, some better than others, illustrate the reality of skinny privilege and backhanded compliments fat people deal with on a daily basis. 

As someone now with a BMI of 32, I had to laugh and shudder at the fact that my weight would soon make me eligible for a potentially life-saving vaccine. Wisconsin isn’t alone in using BMI as an eligibility factor for vaccines. According to The Washington Post, at least 29 states list obesity as a condition that dictates vaccine eligibility.

But here’s the thing, and you can repeat after me: BMI is not an accurate indicator of health, nor is it an adequate measurement of obesity. 

Before going too much deeper, here’s a quick history lesson on the birth of the BMI. The concept of BMI was first introduced in the early to mid 19th century by Adolphe Quetelet, a Belgian astronomer, mathematician, statistician, and sociologist (read: NOT a doctor). The formula is simple: BMI = weight in pounds/(height in inches x height in inches) x 703. (The 703 is to convert the index from the original metric version of the formula.)

Quetelet used the formula as a way to assess the average size of men across a population, not as a means to assess health. The BMI formula also does not take in other considerations that can factor into one’s weight, including bone density and muscle mass. 

More recently scientific studies point to waist measurement as a far more accurate measurement of obesity than BMI. But, the BMI formula is easily replicated and easy for most to understand, so it continues to persist in medicine today.

The way modern medicine treats obesity and overweight people is troubling, to put it mildly. 

The stigma associated with fat bodies has not gone away, and continues to be a barrier when it comes to getting adequate health care. There are countless stories floating around of fat folks who have gone to the doctor seeking help for some ailment only to be told to simply “lose weight” rather than be examined fully, listened to carefully, or be seen as anything other than a product of their weight. This issue only gets worse when it comes to people of color. Fatphobia is rampant in medicine, yet the institutions that uphold these standards fail to self-examine.

While some studies have indicated that individuals with very high or very low BMIs can be more prone to severe cases of COVID-19, a January 2021 study from the International Journal Of Obesity found that a higher BMI does not correlate to a patient’s immune response to COVID-19. 

The announcement that BMI could now make one eligible for COVID-19 vaccines of course opened the floodgates to jokes and discourse online about how its time to “bulk up” to get a vaccine. These jokes are not only crude and short-sighted, they disregard the struggles that overweight and obese people deal with daily. 

Tess Holiday, a noted plus-size model, told The Washington Post:

It has never been easy to exist as a plus-size body in America. We have been ridiculed our entire existence.

I find it really ironic that there’s so many people online joking about how they’re hoping to gain a point or two so that their BMI reaches a level that they needed in order to be vaccinated. No one ever takes plus-size folks’ health seriously.

There’s really no winning in this situation. Increased eligibility for vaccinations is good, yes, but expanding such eligibilities based on archaic formulas is … not so great. But me and my fat friends getting vaccines? That’s great. Until you ask, “How did you get a vaccine?” and the answer comes from a place of shame. 

The guilt that comes with getting a vaccine based solely on weight is a weird feeling to describe. In a world still very much reckoning with “diet culture,” “body positivity,” and “fat shaming,” it seems perhaps counter-productive to bring non-medically-backed weight-based numbers to the forefront of the conversation about a global pandemic.

The notion that weight determines health is one that took me a long time to unlearn. At the time, relying on 19th-century formulas to tell me how much I should weigh in order to be happy was a lot easier than accepting, embracing, and loving the body that I have. 

According to the CDC, in 2017 and 18, 42.5 percent of US adults over 20 were obese and 73.6 percent were overweight. So, by the standards of BMI, odds are that you’re eligible for the vaccine, too.

There’s more where this came from.

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