Why the BMI for Bariatric Surgery Needs to be Lowered

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Weight Watchers. Atkins. Jenny Craig. Keto. How many different diets have you tried with no lasting results? For many people, weight loss surgery is the last straw, a final attempt to lose weight. However, many people on the lower end of the obesity scale may not even qualify for bariatric surgery, despite feeling the negative effects of obesity. Most insurance companies require a BMI of 35 with an obesity-related medical condition. Some companies are, rightfully so, advocating to lower the requirement, as the guideline is a little dated. These guidelines were established nearly 30 years ago and haven’t taken into consideration the advancements and newer understandings of the procedure. Most insurance companies require at least a 35 BMI for bariatric surgery, but many companies and organizations are advocating to lower it.

What is BMI?

BMI is an initialism for body mass index. It’s a tool used to estimate human body fat based on weight and height. It’s calculated by taking the person’s weight in kilograms and dividing it by the person’s height in meters squared. There are several BMI calculators online, including this one from the National Institute of Health. If you weigh yourself in pounds and measure your height in feet and inches, this calculator will do the conversions to the metric numbers for you.

Once the BMI is calculated, it is categorized into a chart to determine if you have potential health risks from your weight. See the chart below for more information. Many patients with a higher BMI tend to have more health problems than those with a lower BMI, but a BMI is not a diagnostic tool. It can’t accurately depict whether someone has a medical condition that needs to be addressed. It simply informs the doctor of the structure of their body.

BMIs are separated into categories for the doctors to determine how your body is likely structured:

BMI Range	Category
Below 15.99	Severely Underweight
16.00-16.99	Moderately Underweight
17.00-18.49	Mildly Underweight
18.50-24.99	Normal Weight
25.00-29.99	Overweight
30.00-34.99	Class I Obesity
35.00-39.99	Class II Obesity
40.00+	Class III Obesity

BMI for Bariatric Surgery

The BMI for bariatric surgery was set by the National Institute of Health in 1991, according to an article from the Oliak Center. The guideline they set is what most insurance companies follow to determine who qualifies for bariatric surgery. They state that your BMI must be above 40 or above 35 with an obesity-related medical condition to qualify for bariatric surgery.

The problem with this standard is that it was set nearly 30 years ago. Bariatric surgery has advanced so much in those 30 years, with newer procedures like the vertical sleeve gastrectomy coming onto the scene. More bariatric operations are becoming laparoscopic rather than open procedures. We also understand bariatric surgery better than we did in 1991, as well as the risks and benefits.

Leaving Out an Obesity Class

There has been a push by many organizations, including the Oliak Center and the American Society for Metabolic and Bariatric Surgery, to reduce the BMI for bariatric surgery to 30. What perhaps the NIH is missing is that you can experience significant obesity-related issues even with a BMI of 30. Bariatric surgery is the most effective treatment for obesity. Diets may work in the short term, but studies find that bariatric surgery works in the long-term. Non-surgical options just aren’t as effective.

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These outdated guidelines set by the NIH are excluding an entire obesity class. Class I Obesity is still obesity and poses several health risks. If we can prevent people from developing more serious health risks before their weight gets too out of control, why aren’t we doing it? Bariatric surgery should be a standard covered medical procedure. If diets worked, we wouldn’t have an obesity crisis around the world. People are dying because of obesity when there is a solution that could help so many people.

Bariatric Surgery and Diabetes

One of the things that fascinate me most about bariatric surgery is the effect it has on insulin. According to the Cleveland Clinic, bariatric surgery is shown to “knock out” Type 2 diabetes within days of surgery due to alterations to the gut hormones. They found that 42 percent of gastric bypass patients and 37 percent of gastric sleeve patients reached non-diabetic blood sugar levels after surgery. Compare that to the 12 percent of patients who reached those levels thanks to medical therapies.

Their studies on bariatric surgery and diabetes were so compelling, they expanded their employees’ health care coverage of weight loss surgery to those with uncontrolled Type 2 diabetes to those with a BMI of 30. They found that surgery costs between $20,000 and $25,000, and they can recoup that cost within four years from savings in prescriptions, doctor visits and prevention of diabetic complications.

For some reason, after bariatric surgery, there is a significant increase in the hormone that stimulates insulin production. Scientists aren’t sure why yet, but they are studying it. For many people, the effect is almost immediate, even before massive weight loss. For example, I went into the hospital as a pre-diabetic with high blood sugar levels controlled by Metformin. After surgery, my blood sugar was always normal, and they had me stop the Metformin. I haven’t taken it since.

My Issues with BMI

I think BMI can be a great indicator of overall health, but too many doctors, hospitals and insurance companies take it as gospel. My issue with BMI is that it doesn’t take into account a person’s muscle mass. Think about it. A bodybuilder with biceps the size of my head has very little body fat. Yet, they have a high BMI because of the size of their muscles. I don’t look at some of these bodybuilders and think “obese.” No, I see someone dedicated to their health and fitness. Obese is the last word I would use to describe them, but I can almost guarantee that they have a BMI in one of the obesity classes.

RELATED CONTENT: Want to learn the 10 changes you need to make in your life to be successful with bariatric surgery? Get our free download here!

I don’t think insurance companies should determine whether someone qualifies for weight loss surgery based on their BMI. I believe that bariatric surgery should be a covered benefit on all insurance plans so that it is accessible to those who need it the most. Bariatric surgery is the most effective treatment for obesity and is making tremendous strides in the fight against Type 2 diabetes. I understand that you should have to meet certain requirements for surgery, but by denying people access to bariatric surgery, the NIH is taking years off their lives.

BMI for Weight Loss Surgery

The NIH needs to update its guidelines to expand access to bariatric surgery to patients in Obesity Class I. Bariatric surgery is life-changing and more people need help, as it’s the most effective treatment for obesity. The tremendous impact on diabetes not only saves lives but money for the insurance companies too. Since BMI doesn’t consider muscle mass, it doesn’t accurately depict someone’s health. Most insurance companies require a 35 BMI for bariatric surgery, but many companies are rightfully advocating to lower the standard.

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