Yesterday, I booked an appointment for my first COVID vaccine shot, as did my boyfriend. It was sheer luck, really, that we were able to get appointments (as you may know, vaccine distribution pretty much everywhere is very messed up).
We’ve both been sitting on the Austin Public Health waitlist for what feels like almost a month, but two weeks ago my therapist told me about how she was able to get vaccinated through a vaccine hub connected to the surrounding county, where I live. So we made our accounts, and since then we’ve been logging in daily. I checked again on Monday, and they happened to have slots open over the next few weeks.
You might be wondering how my boyfriend and I even qualified for the vaccine. My boyfriend was diagnosed with Diabetes when he was seven, but I qualified under one very flawed but specific metric for vaccination if you’re under 65 in Texas: I have a Body Mass Index (BMI) score of 30 or higher, and, according to the state of Texas, am thus considered “Obese” and therefore high-risk enough to need a vaccine. Other states have also qualified fat people for their early vaccine rollouts under definitions of “obesity.”
Most fat people, if not most people who have been afraid of their weight or being fat for any portion of their lives, know what the BMI is. We’ve likely been made aware of the BMI by doctors, or trainers, or weight loss coaches, or the thin people in our lives who feel like they’re just looking out for us. I’m sure many of us, as a result, have used our BMI as a metric in our lives, either for how “healthy” or “unhealthy” we are, or how fat we are, or, horrifyingly, how worthy of care and humanity we are (grim! I know!! but that is fatphobia manifested!).
The other thing that many fat people and people haunted by the fear of being fat might know is that the BMI is a white supremacist, fatphobic metric for health and health disparities, as are the terms around fatness like “overweight” and “obese,” and “super morbidly obese.” The BMI, like many products of scientific research done by and on white men, is a metric rooted in racism that has been misused to dehumanize people.
There is a world of reading on the fat acceptance movement that explore the ways that BMI is invalid, but I often look to Aubrey Gordon, better known as the essayist Your Fat Friend, and the author of What We Don’t Talk About When We Talk About Fat, for explainers on topics such as this. Here’s an excerpt from her piece on the origins of the BMI, created nearly centuries ago by Belgian academic Adolphe Quetelet, emphasis mine. Note that l’homme moyen here means “the average man”:
Quetelet believed that the mathematical mean of a population was its ideal, and his desire to prove it resulted in the invention of the BMI, a way of quantifying l’homme moyen’s. Initially called Quetelet’s Index, Quetelet derived the formula based solely on the size and measurements of French and Scottish participants. That is, the Index was devised exclusively by and for white Western Europeans. By the turn of the next century, Quetelet’s l’homme moyen would be used as a measurement of fitness to parent, and as a scientific justification for eugenics — the systemic sterilization of disabled people, autistic people, immigrants, poor people, and people of color.
While Quetelet’s work was used to justify scientific racism for decades to come, he was clear about one aspect of the BMI: it was never intended as a measure of individual body fat, build, or health. For its inventor, the BMI was a way of measuring populations, not individuals — and it was designed for the purposes of statistics, not individual health.
In recent years, BMI has been used by health insurance companies to determine how to charge people, then adopted by doctors to evaluate weight and health, according to Gordon. BMI is continuously used in these settings, and even outside of medical contexts, to be a metric of how “unhealthy” or “at risk” someone is for health complications, despite the expanding research on BMI indicating that the metric “overestimates fatness and health risks for Black people” and “underestimates health risks for Asian communities,” according to studies published by the Endocrine Society and statements from the World Health Organization, quoted in Gordon’s piece.
Using BMI alone to make assumptions about someone’s health only makes sense if you assume that weighing more, fatness, and being fat are inherently bad and “unhealthy,” and that weighing less and being thin is inherently “healthy.” But if you’ve ever existed in the world you know that your weight is not inherently reflective of what you eat, or if and how you exercise, nor is your health inherently reflected in how you look, or how much you weigh.
I think back to being my thinnest — when I was about 19 and weighed around 150 pounds — and calculating my BMI. Despite being so thin and so sick and cold, all the fucking time, I still teetered between the BMI scores of “normal” (LOL) and “overweight.” And now that I’m still about the same height, and about 100 pounds heavier, and eating and exercising in a way that takes care of me instead of keeps me thin, my BMI is far into the “obese” category. The CDC tells me, “For your height, a normal weight range would be from 115 to 154 pounds.” Knowing my own history of disordered eating, I can’t imagine what I would have had to do to weigh anywhere close to 115 pounds.
Which brings us back to the COVID vaccine, and the people who are being prioritized for getting the vaccine despite being younger than 65. In the state of Texas, people with chronic medical conditions, including “obesity and severe obesity” with a BMI of 30 or higher, qualify for the current round of vaccines. And this is somehow a standard despite the understanding that BMI is not actually a metric of health or a health risk. We are still somehow reaffirming the idea that to have a BMI of 30 or higher is to be inherently unhealthy and at a greater risk for COVID, besides the various other factors — race, gender, class — that contribute to someone’s health outcome, and that it is therefore bad to have a BMI of 30 or higher, because being fat is a bad thing, and fat people should really try to not be fat if they want to survive COVID. Once again, we are presented with inadequate responses from the people who are supposed to have this pandemic under control. It’s disappointing, but not surprising.
And yet, I’ve scheduled an appointment to get a vaccine, knowing full well that BMI is not a precise metric of health, but also knowing the ways that fatphobia has influenced how doctors and nurses care for fat COVID patients during the pandemic, and have in turn influenced outcomes for fat patients.
Part of it feels like I’m gaming the system, because I know that it’s flawed and yet I’m choosing to benefit from it anyway — why validate the use of BMI despite all the reasons to invalidate it? But ultimately, I’ve taken the position that is: “FUCK BMI literally every other day, except in this once instance, where it might protect fat people for once instead of hurt us.”