Black people, and Black women in particular, face considerable health challenges. Compared with their rates in other racial groups, chronic cardiovascular, inflammatory and metabolic risk factors have been found to be elevated in Black women, even after controlling for behaviors such as smoking, physical exercise or dietary variables.

Black women have also been identified as the subgroup with the highest body mass index (BMI) in the U.S., with four out of five classified as either “overweight” or “obese.” Many doctors have claimed that Black women’s “excess” weight is the main cause of their poor health outcomes, often without fully testing or diagnosing them. While there has been a massive public health campaign urging fat people to eat right, eat less and lose weight, Black women have been specifically targeted.

This heightened concern about their weight is not new; it reflects the racist stigmatization of Black women’s bodies. Nearly three centuries ago scientists studying race argued that African women were especially likely to reach dimensions that the typical European might scorn. The men of Africa were said to like their women robust, and the European press featured tales of cultural events loosely described as festivals intended to fatten African women to the desired, “unwieldy” size.

In the eyes of many medical practitioners in the late 19th century, Black women were destined to die off along with the men of their race because of their presumed inability to control their “animal appetites”—eating, drinking and fornicating. These presumptions were not backed by scientific data but instead embodied the prevailing racial scientific logic at the time. Later, some doctors wanted to push Black men to reform their aesthetic preferences. Valorizing voluptuousness in Black women, these physicians claimed, validated their unhealthy diets, behaviors and figures.

Today the idea that weight is the main problem dogging Black women builds on these historically racist ideas and ignores how interrelated social factors impact Black women’s health. It also perpetuates a misinformed and damaging message about weight and health. Indeed, social determinants have been shown to be more consequential to health than BMI or health behaviors.

Doctors often tell fat people that dietary control leading to weight loss is the solution to their health problems. But many studies show that the stigma associated with body weight, rather than the body weight itself, is responsible for some adverse health consequences blamed on obesity, including increased mortality risk. Regardless of income, Black women consistently experience weightism in addition to sexism and racism. From workplace discrimination and poor service at restaurants to rude or objectifying commentary online, the stress of these life experiences contributes to higher rates of chronic mental and physical illnesses such as heart disease, diabetes, depression and anxiety.

A 2018 opinion piece co-authored by psychologists, sociologists, and behavioral scientists in the journal BMC Medicine argued that bias against fat people is actually a larger driver of the so-called obesity epidemic than adiposity itself. A 2015 study in Psychological Science, among the many studies supporting this argument, found that people who reported experiencing weight discrimination had a 60 percent increased risk of dying, independent of BMI (and therefore regardless of body size). The underlying mechanisms explaining this relationship may reflect the direct and indirect effects of chronic social stress.

Additionally, living in racially segregated, high-poverty areas contributes to disease risk for Black women. Low-income Black neighborhoods are often disproportionately impacted by a lack of potable water and higher levels of environmental toxins and air pollution. These factors add to the risk for respiratory illnesses such as asthma and lung disease. They also increase the chance of serious complications from COVID-19.

Further, these neighborhoods typically have a surfeit of fast-food chains and a dearth of grocery stores offering more nutritious food choices. Food insecurity, which is defined as the lack of access to safe, affordable and nutritious foods, has a strong association with chronic illness independent of BMI.

Simply blaming Black women’s health conditions on “obesity” ignores these critically important sociohistorical factors. It also leads to a prescription long since proved to be ineffective: weight loss. Despite relentless pressure from the public health establishment, a private weight-loss industry estimated at about $70 billion annually in the U.S., and alarmingly high levels of body dissatisfaction, most individuals who attempt to lose weight are unable to maintain the loss over the long term and do not achieve improved health. This weight-focused paradigm fails to produce thinner or healthier bodies but succeeds in fostering weight stigma.

Chronic diseases such as diabetes or heart conditions are mislabeled “lifestyle” diseases, when behaviors are not the central problem. Difficult life circumstances cause disease. In other words, the predominant reason Black women get sick is not because they eat the wrong things but because their lives are often stressful and their neighborhoods are often polluted.

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.