Drs Fatima Cody Stanford and Natalie Boero join the AMA Journal of Ethics of Ethics Grand Rounds series to examine the clinical applications of BMI and their effects on patients and how our understanding of the obesity "epidemic" has evolved.

This visual abstract is based on an article from the July 2023 issue of the journal.

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. 

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

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

Underlying ideological foundations of stigma and equipment inadequacy include thin-centrism and inadequate representation of fat people in health care organizational leadership.  

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

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

Weight loss is not a safe, effective, or permanent method of health promotion, and pharmacotherapeutical approaches pose specific risks to adolescents. 

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