Stigma, Bias, and the Shortfalls of Body Mass Index: A Reflection on the State of Weight Management

Obesity is a complex, multifactorial chronic disease. With the development of novel endoscopic techniques and devices for the treatment of obesity, combined with expanding indications for medications, gastroenterologists are more involved in weight management than ever before. Despite the modern definition of obesity as a disease, weight bias and stigma are pervasive in the medical community and beyond. These sentiments contribute to worse outcomes for patients. Furthermore, body mass index (BMI), which is the primary metric to define obesity, does not always approximate visceral adiposity in all populations. A weight-centric model of health, which relies on BMI, misclassifies individuals who may be metabolically healthy at elevated weights. This review will summarize the history of BMI, highlight the problems that arise with a weight-centric model of health, and propose alternative weight-inclusive frameworks for assessment and intervention.