Should body mass index (BMI) be used as a college graduation requirement?

It’s official. America hates fat people.

Human beings are constantly searching for socially sanctioned reasons to feel superior to others and in 2009, those who are thin feel mighty superior to those who are not. How else could a college dare to make body mass index (BMI) a graduation requirement?

According to James DeBoy, the chair of Lincoln’s Department of Health, Physical Education, and Recreation, the point of the new policy is to keep students healthy:

“There’s an obesity epidemic,” DeBoy says. “The data are clear that many young people are on this very, very dangerous collision course with heart disease, diabetes, and stroke—health problems that are particularly bothersome for the African-American community.”

The move by Lincoln University in Pennsylvania is ironic to say the least. Proudly billing itself as “The Nation’s First Black University,” Lincoln seems to have forgotten why it exists in the first place. For two hundred years, irrelevant criteria, like race, have been deemed important requirements for entrance to and graduation from college. Not only has Lincoln University introduced an irrelevant requirement for graduation, but the administration has managed to choose an irrelevant requirement that is more likely to affect black students than those of other races.

Henceforth, all students will be required to endure a physical examination to determine BMI. If the BMI exceeds the arbitrary limit of 30, the student must enroll in “gym” class to qualify for graduation. Lincoln University justifies it discrimination against the overweight by invoking the purest of motives; they’re moved by the humanitarian impulse to preserve health and prevent illness. Oh, really? So why is it bad to overeat but okay to sleep around?

Arguably, promiscuous sexual behavior is responsible for more illness, emergencies, and anguish during the college years than promiscuous consumption of food. Promiscuous sexual behavior is associated with dramatic increases in sexually transmitted diseases, leading to serious infections, hospitalizations, and long term health problems like infertility and potentially fatal diseases like AIDS. Unintended pregnancy causes health problems and psychological distress. If Lincoln University is really concerned about student health, wouldn’t it make more sense to include a pelvic or penile examination as a graduation requirement? Those with sexually transmitted diseases could be forced to attend “health” class to learn about responsible sexual behavior.

And as long as we are talking about regulating student behavior, why is it bad to overeat but okay to drink yourself to death? Alcohol abuse is arguably the most serious health problem at colleges. Perhaps Lincoln University should consider locating sobriety check points throughout the college campus. Random breathalyzer testing could identify students who drink to excess, and then they can be required to take a class on responsible drinking before qualifying for graduation.

Indeed, there are colleges that have instituted specific lifestyle guidelines on drinking and premarital sexual activity, but they do so for religious reasons. They explicitly favor certain lifestyle choices over others and are not afraid to say so. They do not camouflage their views with pious claims of preserving the health of their students.

Regardless of what the administration of Lincoln University tells the world, or even each other, about their motivations for instituting a BMI requirement, the de facto discrimination against overweight students has very little if anything to do with health. If the university were truly worried about student health, they would be addressing the most important threats to student health first, instead of ignoring those altogether. Lincoln University has decided to discriminate against the overweight for the oldest reason in the book: because they can.

Prejudice against the overweight is one of the last remaining social sanctioned prejudices. Never mind that Lincoln University is in the business of education and should be granting degrees based on educational criteria. The opportunity to single out, embarrass and penalize those who overeat was just too hard to resist. Perhaps the administration might consider taking an easier and less expensive route and simply force overweight students wear apparel emblazoned with a scarlet “O.”

When we are raised to believe that prejudice against those who look different is wrong, it is a relief to find a prejudice against those who look different that is right. Overt racism, sexism, ageism and even homophobia are out. Fortunately, discrimination against the overweight has never been more in.

Amy Tuteur is an obstetrician-gynecologist who blogs at The Skeptical OB.

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  • Blake

    Not to mention the fact that BMI is pretty much crap when applied across the boards to an entire population. I know plenty of fit, muscular men who are technically obese. Likewise, I know several fit, stocky men who are also obese. It is a horrible measure when applied to varying body types.

  • Blake

    Not to mention what a horrible standard it is to base a policy upon. I know plenty of fit, muscular men who are technically “obese”. Likewise, I know fit, short, stocky men who are also considered “obese”. It is no good with variations in body-type.

  • Paul Arkay

    Wow! Touch a nerve?

    Regardless of your response, I think that we need to educate everyone, not just the presently obese, about proper fitness and nutrition. We should be doing this in primary, middle and high school, not just colleges. Perhaps this is not some overt discrimination on the obese, as you make it out to be. Perhaps this is a lightning rod, to make us as a nation think about our responsibility to society and what we need to do to keep from shortening our lives.

  • Cospo

    NAZI ideology revisited

  • BladeDoc

    This is awesome. I am learning that there is no line (save perhaps abortion) that the nanny statists will not cross in their zeal to take care of us no matter what we want. Keep it coming, it’s good for laughs.

  • David

    Amy,
    In my opinion, discrimination of all kinds should be legal, so long as the entity doing it is not getting government funds. If it is getting such funds, then strings can be attached which don’t allow for such discrimination. But in most cases, I say let schools live and die by what rules they decide to implement.

    If a person enrolls in a school, and THEN the rules are changed, they should certainly be exempt – or they can file a lawsuit citing breach of contract.

    Your overall points are well-made and certainly it seem sort of weird for a school to become this interested in the bodies of the student body! It is as though they have forgotten their core mission (the actual education), becoming overly interested in things they really shouldn’t make their business. This sort of activism, though, is really common in colleges – and, frankly, goes with a liberal mentality where the individual is meant to conform to ideals prepared by an elite.

    Finally, I think this sort of approach will ultimately backfire on colleges. Colleges survive, partly, by attracting the best and the brightest. Some of those people are overweight – and so – colleges will necessarily be hindering their own progress by deselecting those students. Perhaps a few overweight folks will actually choose the college because they want to lose weight and feel this will be an opportunity – but I suspect most will consider it an imposition and it will tend to push them away from attending.

  • Steven Wynn

    Why do they not make policies against drinking and promiscuous behavior? Simple. You can’t reliably measure risk in those behaviors. BMI is easily measured and positively correlated with poor health.

    I personally think it’s an image thing more than anything, but is it really a bad thing for a school to encourage a healthier lifestyle amongst an unhealthy population. Sure BMI is not perfect, but it’s one of the most cost and time effective measures of obesity.

    While you make an uproar about discriminating against fat people what about discriminating against smokers? Smokers have been getting the shaft for the past few decades. The government has been slowly encroaching on the rights of smokers, but where’s the outcry of that?

    I think it makes sense to “discriminate” against unhealthy behavior, especially given the current movement towards more govt control over our health care system. We will pay for all the overweight people who get diabetes and heart disease through medicare and medicaid. If those people incur more costs on our healthcare, shouldn’t they be responsible for some of those costs?

  • Sam Gaines

    As someone who struggles with weight problems, I’m more than willing to forego health care that exceeds more than my share. If “shaming” is to become the standard for stimulating behavior change (it hasn’t worked for any other social problems, but hey, let’s not let that stop us), then I and other overweight people will hide, as much as we can, or perhaps some government program paying our survivors for our voluntary suicides can be established. Win-win, and all that.

  • http://www.skepticalob.com Amy Tuteur, MD

    “While you make an uproar about discriminating against fat people what about discriminating against smokers?”

    The behavior of smokers hurts other people, and the goal of protecting non-smokers justifies limiting smoking.

  • Laina

    BMI is, first of all, inaccurate. The most common example cited is the muscular, bulky athlete – the weight-to-height relationship might be as high as that of a genuinely overweight or obese person, but obviously the lifestyle, exercise, and dietary habits are significantly more “healthy” (assuming there is no drug, alcohol, eating disorder, etc. contributing to this person’s physical situation).

    Second, genetic or medical considerations need to be made – what about people with hypothyroidism who cannot lose a significant amount of weight, despite being on a strict diet and exercise regimen?

    Most importantly, why must a school take it upon itself to dictate the habits of its students? I understand the purpose of health education, and I support it wholeheartedly, but this is not health education – this is discriminatory and unfair, and does not take into account the possibility that leaner students might seriously benefit from health education as much (or even sometimes more) than “overweight” or “obese” people. Eating disorders are rampant in college-aged women, and at this point in life, it is not particularly difficult to remain lean while maintaining awful exercise and eating habits (I cite my own diet of orange soda and cheese-poofs, maintaining a low BMI)

    If the goal is teaching students who might have unhealthy habits about becoming healthy, a health education class should be mandated for all students, and should include topics such as stimulant abuse, excessive drinking, sexual assault awareness, safer sex and partner communication, stress management, and any of a number of other health topics (including, but most definitely not limited to nutrition and fitness).

  • AnnR

    30 is a very generous BMI. There may be muscular types with a BMI of 30 who aren’t really overweight, but not that many.

    My first thought is that this requirement should be known when one applies to the school. In terms of preparing students for the working world and exposing them to behaviors that are upwardly mobile I think this is probably not a bad idea. If one is trying to move into the upper levels fitness and sports are often hobbies and interests of those who inhabit those classes. Some exposure to the habits and activities of the well-to-do can be beneficial for an aspiring career.

    Is this all that different from those who get a job as a young lawyer and take up golf or racketball so they can play with clients?
    Obesity is a social problem that is more prevalent in the lower classes. If a college is trying to educate it’s students to occupy a slot in the upper classes perhaps schooling in weight management and fitness would help.

  • Medical Student

    I think this article is silly. If you are obese, then you need to take a fitness class? It makes perfect sense to me. Doesn’t the fact that a person is obese indicate that they need to learn more about health and fitness? Is this different from requiring people who do badly on math placement tests to take Algebra?

    Of course, they could make everyone take the class, regardless of their BMI. But if they have limited class space, then it makes sense to exempt the non-obese.

    In any case, the fact that this is a historically black university makes even more sensible. The university is trying to speak to the needs of the black community, and it’s addressing a problem that the black community faces. It is a little politically incorrect, but political correctness is not the best standard for us to judge policies by.

  • http://www.skepticalob.com Amy Tuteur, MD

    In the face of criticism, Lincoln University has backed down and rescinded the policy. According to the Philadelphia Inquirer:

    “In the end, it was the prospect of a predominantly black school being accused of discrimination that led Lincoln University to drop its requirement for an exercise class, the professor who proposed the idea said yesterday….

    DeBoy said that for obese people, “a group that is already facing challenges, ridicule and jokes, the concern that was raised [by the faculty] was: Should the university add to that, especially . . . a historically black college or university.” For most, he said, the answer was no.”

  • Jean

    There are colleges that require students to take a swimming class if they fail a swim test. And Lincoln University tests fitness in addition to BMI (as you can confirm here:
    http://www.lincoln.edu/math/forms/LU-CoreCurriculum.htm). If Lincoln tested solely fitness, without BMI, this would be directly comparable to the swimming requirement.

  • Jean
  • tracy

    There’s medication for hypothyroidism…i’m on it. Sometimes, just have to get used to being hungry…who actually eats three meals a day, anyway? A little (or alot) of hunger can be good for you. Makes you appreciate food more.

  • Diora

    @Paul Arkay — didn’t touch my nerve, I am size 5. But I still think it is not college’ place to dictate individual behavior unless such behavior hurts others. There are many things that affect health – starving yourself like in anorexia or even in elite gymnastics among them as well. You don’t see the college to talk about underweight people, do you? I bet there are some young girls there who are so obsessed with being size 0 that they starve themselves. Not to mention that 30 isn’t exactly that much; I’d imagine many football players have such a BMI.

    @Medical student – algebra is a prerequisite for many majors. There are a number of courses one wouldn’t be able to take if one hasn’t learned algebra. Not all majors are required to take it. I’d be very surprised if a music or dance major is required to take algebra, for example. Now, it may well be a good idea to encourage fitness courses or fitness-related activities by for example organizing hikes or dances or whatever. But as a requirement for graduation it doesn’t make sense. If the college feels fitness is important, they can make fitness course part of overall curriculum for everyone: just because someone is thin doesn’t mean someone is fit. You can be thin and be a couch potato. So why not just make a fitness course part of a curriculum for everyone as humanities or social sciences are?

  • http://www.chemistdirect.co.uk Chemist

    That could be a great idea. Body mass index during college gradualtion will help students to cope up with their weights and put up an healthy lifestyles

  • Anonymous

    30 is a very generous BMI. There may be muscular types with a BMI of 30 who aren’t really overweight, but not that many.

    There are not that many athletes heavy with muscle in the general population (though the percentage of such is likely higher in university student age people than all adults), so BMI works reasonably well for population studies. But such athletes heavy with muscle are why BMI is not a good measure of fatness for an individual. Even relatively crude body fat percentage formulae using waist size in addition to height and weight would be an improvement for individual assessment.

    Note also that some population studies have found that African Americans on average tend to have slightly lower body fat percentage for the same BMI, or slightly higher BMI for the same body fat percentage, compared to European Americans on average.

  • http://teddydouglas.blogspot.com TD

    Hey, cool it. It seems all they did was say that if you’re overweight, you need to take a gym class. At most colleges I know of, EVERYBODY has to take a gym class.

  • David Deitsch, RN

    “If you are obese, then you need to take a fitness class? It makes perfect sense to me. Doesn’t the fact that a person is obese indicate that they need to learn more about health and fitness?”

    No, it does not. People flunk math classes because they do not know enough about math, so remedial education can solve their problem. Do you really think that obese people are obese because they do not know that eating a lot of food and getting little exercise results in obesity? Obesity results from complex interactions of genetic, metabolic, psychological, and sociological factors, with a side-dish of personal preference. Since obesity is not caused by inadequate education, more education will not result in a change in outcomes.

  • David Deitsch, RN

    Getting back to the original question. Why are the college administrators limiting graduation requirements to BMI? Clearly this does not go far enough. They should also set criteria number of dental carries, hemoglobin levels, SMAC panel results (nothing outside normal allowed!), and the results of genetic testing for vulnerability to future pathologies. This will ensure that the benefits of higher education are limited to tall, lean, blond-haired, blue-eyed specimens of physical superiority fit to lead society and reproduce superior offspring. Hmmm. Wait a minute. didn’t someone try this around the middle of the last century? Anyone remember how that worked out?

  • Jill

    I lost a heap of weight after a serious illness. I didn’t consider myself “fat” beforehand but I was overweight. My new weight is still “overweight” according to the BMI..I’ve never been lighter in my adult life and I’ve never been fitter. After the illness, I took up weight classes, kick boxing and pilates.
    I find that depressing…
    My doctor said to forget about it and don’t worry too much about the scales either…go on my appearance and how my clothing fits…at size 12, I certainly don’t feel or look fat. (Australian size)
    This proposal is outrageous and you have to question the ethics of the people involved in that decision. It should cause a storm of protest from everyone.
    It’s like designers who don’t make dresses over size 10 or 12 because they don’t want “fat” people in their clothing. Never admitted, but I’ve worked in the industry.
    Overweight people are talked down to, made fun of and people judge them all the time.
    Why not offer gyn classes for overweight students? Something constructive for a change….this idea worked well at my University….overweight people often feel embarrassed in classes staring into the gorgeous backside of a size 8…these classes also offered a supportive environment.

  • Anon

    It is well known that some very overweight women have been sexually abused in their past and consciously or unconsciously, want to be unattractive to men. They don’t want male attention.
    I saw this with a friend…she was happy and felt protected at 115 kilos. She started losing weight at 42 probably because she felt less threatened by men. She’s now 67 kilos and getting on with life.
    It is indeed a complex area and lots of factors come into play.

  • Aestivate99

    shaming people is a stupid approach and shameful itself. I wonder how many grants this school hoped to get to put this all in place? Everyone is giving them out for just about any project you can dream up.

  • http://www.gainesaying.com Sam Gaines

    Lynn,
    I had a similar experience to yours after cancer surgery and a year of chemo — lost 40 lbs., and when I felt well enough to return to the gym, I eased myself back into it. Started putting weight back on gradually, without intending to, even with a restricted diet and 6x intense workouts/week. Even at my reduced weight, I still was considered obese — and I hadn’t been in shape like that since my high school athlete days. It’s terribly frustrating and depressing. I’m trying to get down to the weight BMI says I should have given my age and height, but it’s kind of ridiculous to imagine it possible — unless of course I go through extended chemo again.
    The gym I belong to has an interesting approach: it directly appeals to all body types by branding itself the “no judgment zone” and keeping monthly rates low. All kinds of body types there. I think they’re onto something.
    I believe we should always pursue good healthy habits, but also realize that weight and obesity are not, as is frequently cited, a simple matter of “calories in/calories out.” BMI is, as I understand it, an old scale created by an insurance company, based on little evidence (and all of that dating back to the early 1970s) and is remarkably simplistic for evaluating a complex issue.
    As a university policy, I can see mandating group exercise (as simple as walking, even) for students, both as a way to encourage good health and as a valuable stress relief. Getting a positive message out there about the benefits of exercise per se, without stigmatizing anyone, would go a long way toward this.

  • http://www.fatso.com Marilyn Wann

    Thanks for the healthy (and health-enhancing) skepticism, Dr. Tuteur!

    I invite you to acquaint yourself with the work of fat rights activists, fat studies scholars, and Health At Every Size healthcare professionals and researchers. To start, I recommend…

    Health At Every Size: The Surprising Truth About Your Health, by Linda Bacon, PhD

    Fat Studies Reader, edited by Sondra Solovay, JD, and Esther Rothblum, PhD, just published by NYU Press

    And my own, still-in-print classic…
    FAT!SO?—Because You Don’t Have to Apologize for Your Size.

    Thanks. Medical doctors have created a world of hurt, bigotry, and discrimination with their focus on weight and weight loss. If you offer public skepticism for the hysteria-mongering, you stand to make a significant contribution to social justice and public health.

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