AMA Journal of Ethics^®

While useful in analyzing population trends in relative body weight, BMI possesses multiple shortcomings when used as an individualized health screening tool.

BMI is part of a range of clinical screening and gatekeeping practices, but historical and current uses reinforce inequity and exclusion.

Before the late 20th century, overweight and obesity were not considered population-wide health risks, but the advent of weight loss drugs in the 1990s accelerated hypermedicalization via BMI use. 

Size-based health and beauty ideals emanated from eugenic pseudoscientific postulates, and BMI continues to advance white supremacist embodiment norms. 

Use of body mass index as a health care metric is controversial, especially in candidacy assessments for gender-affirming surgery.  

Despite concerns about clinical outcomes for patients with obesity, clinical trials report few data about such patients.

Healthist views about body shape and weight are oppressive and lead to pernicious harms, especially to members of vulnerable groups. 

In the early 20th century, the United States, as an industrialized nation with more food than ever, began to grapple with obesity.

Despite common outcomes of GRS, decision making about surgical care differs among patients across the lifespan.

Body mass index cutoffs are routinely used to assess eligibility for gender-affirming surgeries, yet they are not empirically based.