You have likely done plenty of research on bariatric surgery and know that the Body Mass Index or BMI is the primary tool for measuring whether a patient qualifies for bariatric surgery. According to 1991 federal guidelines, patients with a BMI of 35 or more with one or more obesity-related comorbidities may qualify for bariatric surgery. Patients with a BMI of 40 or over may be eligible regardless of their obesity-related conditions. That said, the definition of obesity is arbitrary because the BMI does not consider many of the traits and qualities that make us all different. For example, the degree to which obesity or excess weight may be problematic varies based on race, body type, musculature, and gender; even where you keep and accumulate your fat can make a significant difference in the risk of follow-on diseases.
Major bariatric societies like the ASMBS (American Society for Bariatric and Metabolic Surgery) and IFSO (International Federation for the Surgery of Obesity and Metabolic Disorders), as well as bariatric surgeons, see this every day. We have patients who visit us with often-significant health issues, but they do not qualify for bariatric surgery because their BMI is relatively low. Yet, metabolic and bariatric surgery aims to treat excess weight-related diseases. What gives?
To start closing this gap, the ASMBS and IFSO recently released new bariatric surgery guidelines. The recommendations better reflect the reality of excess weight and related comorbidities. For example, new guidelines suggest that bariatric surgery should be considered when a patient reaches a BMI of 30 with one or more comorbidities or when patients have a BMI of 35 or more regardless of comorbidities. This five-point drop in BMI guidelines means that millions more patients may have the option to treat their excess weight surgically and address potentially severe obesity-related problems.
The guidelines also address a few other truths. We know from experience and long-term data that people of Asian descent should consider bariatric surgery at a lower BMI. This new consensus pegs that level at 27.5 or more. Asian patients have shown a greater risk of obesity-related diseases at a somewhat lower BMI than other races. Also, the new guidelines address the somewhat controversial topic of adolescent bariatric surgery – for those under 18. While previous guidelines are slightly unclear on whether adolescent bariatric surgery is problematic in a growing child, we now know that, in specific cases, adolescent bariatric surgery can be safe. Of course, heightened caution must be employed when performing any surgery, including weight loss surgery on a child.
Do These Guidelines Carry Any Weight?
The answer to this is nuanced. On the one hand, research like this helps guide practices, insurance companies, and even lawmakers on future policies. However, they hold no legal or regulatory weight in their current form.
We look forward to seeing how these new guidelines influence future policy and hope that regulatory powers will understand the limitations of current policy and make swift changes.
If the BMI Is Not Accurate, What Should We Use Instead?
Recent research has shown that using waist size and the location of accumulated visceral fat is a better representation of the risks of obesity than BMI alone. The relationship is somewhat independent. Many patients with significant abdominal fat but a relatively lower BMI may still suffer from obesity-related diseases, whereas patients with a relatively higher BMI but less abdominal fat may not.
Other markers of metabolic disease should also be used to qualify patients for surgery. Often, patients with lower BMIs may still suffer from type two diabetes, high cholesterol, and high blood pressure, all of which can be treated quite successfully with bariatric surgery.
Of course, if you want to learn more about bariatric surgery or weight loss, we encourage you to contact our office. Not only do we have a surgical weight loss program, but we also offer non-surgical/physician, supervised weight loss for qualifying patients.