Thank you Scientific American for publishing my response to sociologist Sabrina Strings, Ph.D’s “The Racist Roots of Fighting Obesity” in the July 2020.
“As a Black woman and a physician, I have personally and professionally seen the deleterious effects of obesity that extend beyond subjective aesthetics....” Full response here:
After reading the article I read Dr. Strings book “Fearing the Black Body: The Racial Origins of Fat Phobia.” In the book, Dr. Sabrina Strings highlights the historical shift from the full-figured body type being considered the standard of beauty as slavery and racism increased globally. She convincingly argues that the ideal of thinness became associated with white purity and moral rectitude as a means of dehumanizing Black people who generally were naturally more full-figured. It is clear there are racial differences as well as disparities associated with African American obesity rates. Furthermore, it is undeniable that faulty racist ideology has facilitated bias and disparities in obesity diagnosis and treatment. In The Racist Roots of Fighting Obesity, Strings and Bacon assert “blaming Black women’s health conditions on ‘obesity’ ignores …critically important sociohistorical factors. It also leads to a prescription long since proved to be ineffective: weight loss….The most effective and ethical approaches for improving health should aim to change the conditions of Black women’s lives: tackling racism, sexism, and weightism and providing opportunity for individuals to thrive” Strings and Bacon’s assertion only provides a partial solution to improve African American health.
As Black woman and a physician, I have personally and professionally seen the deleterious effects of obesity that extend beyond subjective aesthetics. I agree that forcing individuals to conform to specific body types that are rooted in racism, classism and sexism is unhealthy and potentially harmful. But given the evidence of the increased all-cause mortality associated with obesity—especially at a BMI greater than 35—it would be a disservice not to address it in African-Americans. The work Strings and Bacon describe does not invalidate the need for obesity treatment in African-American patients with diseases related to the condition. Rather it reemphasizes that such treatment must comprehensively address nutrition, physical activity, behavior and, if needed, medication or bariatric surgery.
Furthermore reexamining the historical context of our most commonly used screening tool, the body mass index or BMI, is a reminder of the inherent limitations and potential harms of using the same BMI standard for all races and ethnicities. It is well documented that the BMI overestimates being overweight and at times obesity in black people due to differences in muscle mass vs fat percentage. Dr. Fatima Cody Stanford & colleagues have proposed the use of a BMI threshold that is adjust for race/ ethnicity, gender and the presence of obesity related risk factors and/ or conditions. The widespread adaptation of these appropriately adjusted BMI cutoffs would facilitate more accurate diagnosis of obesity especially in Black people.
We are truly at a pivotal time in history as we welcome Kamala Harris, the first Black Vice President of the United States while attempting to rectify the widespread harmful effects of racism. In Obesity Medicine we must acknowledge the impact of the past and make the necessary adjustments to ensure the best diagnosis and treatment for all especially our Black/ African-American patients.