Beyond the BMI: The Search for Better Guidelines for Bariatric Surgery

Abstract

The application of the BMI of ≥35 as the major prerequisite for access to bariatric surgery is no longer appropriate because the index, now incorporated in the requirements of Medicare, Medicaid and most private carriers, does not reflect the degree or distribution of adiposity, it discriminates unfairly on the basis of gender, race, age, fitness, and body fat composition. Further, with increasing evidence that bariatric surgery can also induce full and durable remission of such comorbidities as type 2 diabetes even in patients with BMIs <30, new guidelines must be pursued.

Using the Edmonton obesity staging system to predict mortality in a population-representative cohort of people with overweight and obesity

“…This approach has been criticized, and recommendations for scoring systems that incorporate assessments of comorbidity have been proposed as alternatives. 9 Recently, we proposed a new clinical staging system that ranks people with excess adiposity on a 5-point ordinal scale, while incorporating obesity-related comorbidities and functional status into the assessment (Box 1). 6 The Edmonton obesity staging system is intended to complement anthropometric measures, but it requires further validation.…”

“…The practice of selecting patients using BMI alone has been criticized as inaccurate and arbitrary and may result in the selection of patients who are least likely to benefit from weight reduction. 9 Prioritizing patients with higher Edmonton obesity staging system scores -and thus greater comorbidity and risk of death -may help maximize the benefits of surgery. Further study, including full characterization of the risks and benefits, especially for patients with the highest scores, is required.…”

Operative Outcomes of Bariatric Surgery in Patients with a Low Body Mass Index (30–35 kg/m2)

“…For instance, in patients with a BMI of 35 kg/m 2 , the fat percentage is 46 % in females and 35 % in males; therefore, the metabolic outcomes will probably be different between these patient populations [ 1 ].…”

“…By ignoring other parameters such as race, gender, age, and fat distribution, this arbitrary system excluded many patients who could benefi t from this life-saving treatment [ 1 ]. In addition, there is increasing evidence that bariatric surgery in patients with a lower BMI may have a positive effect on type 2 diabetes mellitus (T2DM) remission as well as other comorbidities, which provides a strong argument for performing bariatric surgery in patients with lower BMI.…”

O processo de tomada de decisão da mulher obesa pela cirurgia bariátrica: uma abordagem compreensiva

“…Além disso, pode induzir um processo de desmineralização óssea e um aumento do número de evacuações diárias (36) . (37) .…”