Episode Details

One of the ways that weight stigma harms fat people is through Body Mass Index BMI (and other weight-based) limits. BMI is a ratio of weight and height, and its use is deeply problematic in multiple ways. BMI and weight-based healthcare denials occur when people above a certain BMI or weight are refused medical procedures unless or until they meet the BMI or weight requirement. In part 1 of this three-part series, I’ll offer a general discussion of these limits, in part two I’ll provide some options and resources to help fight them, in part three I’ll share the story of someone who successfully fought BMI-based denial of surgery. I previously published specific resources to fight joint surgery denials and moving forward I will be compiling resources for other common types of denials as well. If you have a specific request, please feel free to share in the comments or email me directly. I do want to note that, while this information can be helpful to people outside of the US, these posts will focus on the US healthcare system.

BMI limits are typically “justified” based on the idea that there are higher risks of complications during or after procedures for people above a certain BMI vs people below that BMI, or that higher-weight people’s outcomes won’t be as good as thinner people’s outcomes.

The first thing I want to point out is that this is blanket discrimination based on a simple height/weight ratio. The people whose care is being denied can and do vary wildly in everything from body composition to metabolic health and more. The use of BMI also codifies racism and anti-Blackness into the process and I urge you to read Sabrina Strings’: Fearing the Black Body – the Racial Origins of Fat Phobia and Da’Shaun Harrison’s: Belly of the Beast: The Politics of Anti-Fatness as Anti-Blackness to learn more.

BMI limits are based on, and further perpetuate, weight stigma. In our current healthcare system, research, tools, best practices, education, and training are very often developed based on thin bodies (and to the exclusion of fat bodies,) so even if someone believes that higher-weight people have more complications and/or worse outcomes, that wouldn’t be surprising due to the ways that weight stigma impacts every level of their care. What BMI-based denials do is take this weight stigma further by deciding that instead of getting better at providing care to fat people, or at least allowing them to consent to take possibly greater risks in order to get care that can improve their health, quality of life, or potentially save their lives, higher-weight people will simply be denied care unless or until they become thinner.

There are other issues with BMI limits as well:The research that is used to justify these denials can be questionable (at best,) and/or contradicted by other evidence which is not taken into account.

Often patients are denied needed surgeries, but are then referred to weight loss surgery. This is particularly ridiculous when the risk cited in the former surgery is anesthesia (as if weight loss surgeries don’t also use anesthesia,) and/or the risks of the weight loss surgery far exceed those of the surgery the patient actually needs. When a doctor denies a needed surgery and refers the patient to weight loss surgery it’s important to understand that the doctor is mitigating their risk (of having a patient with complications/poorer outcomes) by recommending that t