The BMI: Is It Time to Scratch for a More Accurate Assessment of Metabolic Dysfunction?
The body mass index (BMI = Kg/M2) is not a valid measure for clinical decisions, especially whether a patient will benefit from bariatric surgery. The measure, as used, discriminates against the muscular, the aged, women, and racial groups such as Asians and African Americans. The requirement must be eliminated since it denies many patients the only currently available therapy. This chapter provides the bibliographic data to support this argument and should prove useful in convincing carriers that the BMI is an inaccurate and, too often, cruel guideline.
KeywordsBMI Obesity Bariatric surgery Metabolic syndrome
Compliance with Ethics Guidelines
Conflict of Interest
E. Charles Moore declares that he has no conflict of interest.
Walter J. Pories has received grant support from Johnson & Johnson, Ethicon, Golden Leaf, GlaxoSmithKline, and National Institutes of Health.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
- 1.Gastrointestinal surgery for severe obesity: National Institutes of Health Consensus Development Conference Statement. Am J Clin Nutr. 1992;55(2 Suppl):615S–9S.Google Scholar
- 4.••Schauer PR, Kashyap SR, Wolski K, Brethauer SA, Kirwan JP, Pothier CE, et al. Bariatric surgery versus intensive medical therapy in obese patients with diabetes. N Engl J Med. 2012;366(17):1567–76. Critical reference. Prospective randomized study of surgical vs. medical therapy for type 2 diabetes.PubMedCentralPubMedCrossRefGoogle Scholar
- 5.••Look AHEAD Research Group, Wing RR, Bolin P, Brancati FL, Bray GA, Clark JM, et al. Cardiovascular effects of intensive lifestyle intervention in type 2 diabetes. N Engl J Med. 2013;369(2):145–54. Extensive, very expensive study that documented the failure of diets in the treatment of obesity and its co-morbidities.PubMedCrossRefGoogle Scholar
- 6.Ikramuddin S, Korner J, Lee WJ, Connett JE, Inabnet WB, Billington CJ, et al. Roux-en-Y gastric bypass vs intensive medical management for the control of type 2 diabetes, hypertension, and hyperlipidemia: the Diabetes Surgery Study randomized clinical trial. JAMA. 2013;309(21):2240–9.PubMedCrossRefGoogle Scholar
- 7.James PD, Kaplan GG, Myers RP, Hubbard J, Aziz M, Shaheen A, et al. Decreasing mortality from acute biliary diseases requiring endoscopic retrograde cholangiopancreatography: a nationwide cohort study. Clin Gastroenterol Hepatol. 2013;pii: S1542-3565(13):01467–5.Google Scholar
- 8.Metabolic syndrome. http://www.en.wikipedia.org/wiki/Metabolic_syndrome. Accessed 10 Oct 2013.
- 10.WHO. BMI Classification. http://apps.who.int/bmi/index.jsp?introPage=intro_3.html. Accessed 10 Oct 2013.
- 12.Anand SS, Yusuf S, Vuksan V, Devanesen S, Teo KK, Montague PA, et al. Differences in risk factors, atherosclerosis, and cardiovascular disease between ethnic groups in Canada: the Study of Health Assessment and Risk in Ethnic groups (SHARE). Lancet. 2000;356(9226):279–84.PubMedCrossRefGoogle Scholar
- 16.Average BMI for NFL players. http://www.sportingcharts.com/articles/nfl/what-is-the-average-bmi-of-an-nfl-player.aspx. Accessed 10 Oct 2013.
- 22.Chang H, Simonsick E, Ferrucci L, Cooper J. Validation study of the body adiposity index as a predictor of percent body fat in older individuals: Findings from the BLSA. J Gerontol A Biol Sci Med Sci. 2013.Google Scholar