A Child’s BMI Does Not Determine Their Health

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Heading to the doctor’s office is a kid’s nightmare. Every day, children see their doctor for a regular checkup or a cold, but they leave with a clear message: "Your body is wrong. Go on a diet." I was 10 years old when my pediatrician first talked to me and my mom about Weight Watchers, a “wellness” program that I now recognize as a pretty direct kid-to-eating-disorder pipeline. But why did my doctor put me on a diet at age 10? One reason exactly: BMI.

What is BMI, actually?|What is BMI, actually?

The focus on physical body size over all other measurements of health can be deadly for children|The focus on physical body size over all other measurements of health can be deadly for children

In December 2021, US Surgeon General Dr. Vivek Murthy declared a youth mental health crisis, stating that "even before the pandemic, an alarming number of young people struggled with feelings of helplessness, depression, and thoughts of suicide — and rates have increased over the past decade.” National data shows that about 7-8% young people attempt suicide each year, and about 17% divulge having experienced serious suicidal ideation. Young people are also significantly at risk for eating disorders. Global reports indicate that one in five children show signs of disordered eating, leaving them more likely to think about, attempt, and die from suicide.

So why the hyperfocus on BMI and obesity?

In society, simple solutions are valued over complex analysis of complex subjects. It’s much easier to say if you’re this BMI, you’re unhealthy, instead of examining the complex and varying factors that go into a person’s health. An oversimplification of children’s health specifically has led to a hyperfocus on weight loss, including extremely concerning recommendations for bariatric surgery as young as 13 years old. One 2020 article from the Journal of the American Medical Association discusses the specific focus on weight loss in youth, stating that weight control efforts “rarely result in health improvement or sustainable weight loss and are instead associated with disordered eating and greater weight gain.”

But despite the evidence, weight stigma, which can be defined as “discriminatory acts and stigmatizing beliefs directed toward those perceived to carry excess weight,” perpetuates the use of BMI.

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In December 2021, US Surgeon General Dr. Vivek Murthy declared a youth mental health crisis, stating that "even before the pandemic, an alarming number of young people struggled with feelings of helplessness, depression, and thoughts of suicide — and rates have increased over the past decade.” National data shows that about 7-8% young people attempt suicide each year, and about 17% divulge having experienced serious suicidal ideation. Young people are also significantly at risk for eating disorders. Global reports indicate that one in five children show signs of disordered eating, leaving them more likely to think about, attempt, and die from suicide.

So why the hyperfocus on BMI and obesity?

In society, simple solutions are valued over complex analysis of complex subjects. It’s much easier to say if you’re this BMI, you’re unhealthy, instead of examining the complex and varying factors that go into a person’s health. An oversimplification of children’s health specifically has led to a hyperfocus on weight loss, including extremely concerning recommendations for bariatric surgery as young as 13 years old. One 2020 article from the Journal of the American Medical Association discusses the specific focus on weight loss in youth, stating that weight control efforts “rarely result in health improvement or sustainable weight loss and are instead associated with disordered eating and greater weight gain.”

But despite the evidence, weight stigma, which can be defined as “discriminatory acts and stigmatizing beliefs directed toward those perceived to carry excess weight,” perpetuates the use of BMI.

The thing is, BMI isn’t just a terribly outdated and inaccurate tool – it’s actually killing people. It negatively impacts those in larger bodies, in particular, and, as a direct result, the majority of doctor visits for patients in larger bodies are recorded as lasting a shorter length of time than visits from folks in thinner bodies for the same ailment. When it comes to determining a child’s health or diagnosis, many healthcare practitioners ignore and gloss over higher weight children’s ailments, pointing to their physical appearance and BMI rather than doing a thorough physical exam or mental wellness check.

I know a lot of parents are worried about their kid(s)' weight and risk for type 2 diabetes – so were mine. I’d like to challenge that concern with some hard truths. The reality is that a child is 242 times more likely to have an eating disorder than they are to have type 2 diabetes, according to research from the 2014 book Body Respect by Lindo Bacon and Lucy Aphramor.

Registered dietician Alissa Rumsey emphasizes, “If you took a sample of 100,000 children, only 12 would have type 2 diabetes, whereas 2,900 would meet the criteria for an eating disorder.” Learning more about eating disorders and the warning signs is critical as the focus on BMI and weight loss for children intensifies.

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The thing is, BMI isn’t just a terribly outdated and inaccurate tool – it’s actually killing people. It negatively impacts those in larger bodies, in particular, and, as a direct result, the majority of doctor visits for patients in larger bodies are recorded as lasting a shorter length of time than visits from folks in thinner bodies for the same ailment. When it comes to determining a child’s health or diagnosis, many healthcare practitioners ignore and gloss over higher weight children’s ailments, pointing to their physical appearance and BMI rather than doing a thorough physical exam or mental wellness check.

I know a lot of parents are worried about their kid(s)' weight and risk for type 2 diabetes – so were mine. I’d like to challenge that concern with some hard truths. The reality is that a child is 242 times more likely to have an eating disorder than they are to have type 2 diabetes, according to research from the 2014 book Body Respect by Lindo Bacon and Lucy Aphramor.

Registered dietician Alissa Rumsey emphasizes, “If you took a sample of 100,000 children, only 12 would have type 2 diabetes, whereas 2,900 would meet the criteria for an eating disorder.” Learning more about eating disorders and the warning signs is critical as the focus on BMI and weight loss for children intensifies.

Kids are humans, not numbers|Kids are humans, not numbers

As an adult, I go to the doctor’s office hesitantly. Every time I have ever walked into an exam room, from age 10 to present day, I have been told to go on a diet. I’ll add here cheekily that despite being in an “exam” room, I am not always examined, and I am almost never asked about my eating habits, receiving a disbelieving glance at my body while being asked, “Do you exercise?”

I am a fat adult, and I am OK with that. I am a leader in my field, beloved by friends and family and respected by colleagues and peers. Simply being a fat kid did not impact my overall health. Being a fat kid who experienced repeated harm and stigma at the doctor’s office because of my BMI did impact my health.
Any time a single number defines a whole human being (and, yes, children are whole human beings), there is a huge risk that the human will be overlooked. Think about your kid, your friends, your siblings, yourself. Think about what life could have been like if you weren’t judged as a kid based on your exterior. Now think about how much worse it could have been if you were told by your doctor you’re not enough. For my fellow fat kids out there, think about how that impacted your life.

And one last time for the people in the back: there is no scientific evidence that the BMI should be used as the main indicator of an individual’s health. It’s not logical, ethical, or precise… but one thing’s for certain: It is bullsh*t – especially for kids.

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As an adult, I go to the doctor’s office hesitantly. Every time I have ever walked into an exam room, from age 10 to present day, I have been told to go on a diet. I’ll add here cheekily that despite being in an “exam” room, I am not always examined, and I am almost never asked about my eating habits, receiving a disbelieving glance at my body while being asked, “Do you exercise?”

I am a fat adult, and I am OK with that. I am a leader in my field, beloved by friends and family and respected by colleagues and peers. Simply being a fat kid did not impact my overall health. Being a fat kid who experienced repeated harm and stigma at the doctor’s office because of my BMI did impact my health.
Any time a single number defines a whole human being (and, yes, children are whole human beings), there is a huge risk that the human will be overlooked. Think about your kid, your friends, your siblings, yourself. Think about what life could have been like if you weren’t judged as a kid based on your exterior. Now think about how much worse it could have been if you were told by your doctor you’re not enough. For my fellow fat kids out there, think about how that impacted your life.

And one last time for the people in the back: there is no scientific evidence that the BMI should be used as the main indicator of an individual’s health. It’s not logical, ethical, or precise… but one thing’s for certain: It is bullsh*t – especially for kids.

Worried about your child’s health? Consider these factors|Worried about your child’s health? Consider these factors

  1. Individuals can be healthy or unhealthy at any size, a principle commonly referred to as Health at Every Size (HAES). For many decades, the definition of physical health has been the most common definition of health period, but the real meaning of “health” is much more complex.
  2. Health is determined by many factors. The Centers for Disease Control says that health is determined by a number of factors, including genetics, behavior, environmental and physical influences, medical care, and social factors. BMI should not be considered the sole determinant of health but should instead be only one deprioritized consideration alongside mental health, emotional and spiritual well-being, financial security, environmental safety, physical and mental ability, behavioral habits, cultural influences, and more.
  3. Eating disorders are widely prevalent. At least one in ten people in the U.S. will be diagnosed with an eating disorder in their lifetime, and 95% of first-time eating disorder cases begin by age 25.
  4. Children are more at risk for suicide. Engage in hard conversations, and offer resources and support.
  1. Be an advocate for your child. Know the right questions to ask at the doctor's office.

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  1. Individuals can be healthy or unhealthy at any size, a principle commonly referred to as Health at Every Size (HAES). For many decades, the definition of physical health has been the most common definition of health period, but the real meaning of “health” is much more complex.
  2. Health is determined by many factors. The Centers for Disease Control says that health is determined by a number of factors, including genetics, behavior, environmental and physical influences, medical care, and social factors. BMI should not be considered the sole determinant of health but should instead be only one deprioritized consideration alongside mental health, emotional and spiritual well-being, financial security, environmental safety, physical and mental ability, behavioral habits, cultural influences, and more.
  3. Eating disorders are widely prevalent. At least one in ten people in the U.S. will be diagnosed with an eating disorder in their lifetime, and 95% of first-time eating disorder cases begin by age 25.
  4. Children are more at risk for suicide. Engage in hard conversations, and offer resources and support.
  1. Be an advocate for your child. Know the right questions to ask at the doctor's office.