BMI and Bariatric Surgery

Long Relied Upon Measure Being Questioned

posted by Bariatric Skinny Editorial Team
filed under Bariatric Surgery postings

Obesity has become a prevalent problem in the United States and many other parts of the developed world. Morbidly obese patients often elect bariatric surgery for treatment. In some cases, obese patients choose weight loss operations, subjecting themselves to the potential risks related to gastric bypass, gastric banding (Lap-Band, etc.), gastric sleeve and other surgical procedures, despite being otherwise healthy – no signs of diabetes, hypertension, sleep apnea, or other obesity-related diseases.  Many obese patients opting for surgery indicate that they are concerned that their obesity will shorten their lives, despite having been obese and otherwise healthy for many years. According to a recent editorial article published in The Journal of the American Medical Association, on average, obese patients do have an increased mortality rate, but life span is only minimally reduced when other comorbidities, like diabetes, are not present.


Bariatric surgeries are conducted on the principle that patients become healthier and live longer due to surgically induced weight loss. The initial criteria for weight loss surgeries were developed by experts at the National Institutes of Health (NIH) in 1991. Information on bariatric surgery was fairly limited at that time. The NIH acknowledged that lack of information when establishing accessibility to weight loss operations for patients with a BMI greater than 40 or a BMI greater than 35 with an existing obesity-related condition. The decision was based in part on the belief that high BMI was associated with increased mortality. 


However, two decades later, studies show a more complicated relationship between bariatric surgery and mortality in which life spans are only minimally increased by weight loss surgery and that BMI does not necessarily reflect body composition or other health dangers related to being overweight. Since body weight and BMI do not indicate body fat collection and distribution, some experts suggest that BMI should not be the only criteria used to determine when a patient should have bariatric surgery. For example, patients that have large amounts of central fat (i.e. around the middle and upper parts of the body) are more likely to develop metabolic syndrome than those who have more peripheral fat.


Just being overweight may not be informative enough when making the decision to undergo bariatric surgery. Weight loss surgery does lead to weight loss but the benefit of longevity resulting from these procedures has not yet been definitively proven. Dr. Edward H. Livingston of The Journal of American Medical Association argues in the aforementioned editorial article that patients with lower BMI and no other weight-related health condition should not necessarily undergo bariatric surgery.


Source: The Journal of the American Medical Association

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