Inadequacy of BMI as an Indicator for Bariatric Surgery

BMI doesn’t distinguish between body fat and muscle mass, which weighs more than fat. Many NFL players have been labeled “obese” because of their high BMI, when they actually have a low percentage of body fat.

Inadequacy of BMI as an Indicator for Bariatric Surgery 
JAMA. 2012;307(1):88-89
Edward H. Livingston, MD
http://jama.jamanetwork.com/article.aspx?articleid=1103978

In response to overnutrition, some patients preferentially accumulate peripheral rather than central fat, preventing development of the metabolic syndrome.
When the ability to accumulate subcutaneous fat is limited, overeating results in central obesity and ectopic fat deposition that causes insulin resistance, diabetes, and ultimately life-limiting cardiovascular disease.
Thus, fat distribution, not overall fatness, is a critical determinate of the health risks of obesity.

The Unease Over Classifying Obesity As A Disease

The Unease Over Classifying Obesity As A Disease
June 24, 2013
http://www.npr.org/templates/story/story.php?storyId=195194243

More than 1 in 3 Americans are obese, and the problem isn’t shrinking. The American Medical Association recently voted to classify obesity as a disease, but not everyone likes the decision.

Dr. Patrice Harris is a member of the board of the American Medical Association. She’s also the director of Public Health in Fulton County, Georgia.

Dr. Neil Minkoff is a medical consultant at Fountainhead HealthCare in Boston. He formerly practiced as an internist. He’s also a regular contributor to our barbershop roundtable.

Dr. William Stratbucker is a physician who specializes in obesity, in Grand Rapids, Michigan.

semantics … obesity’s designation as a disease

MINKOFF: I have two concerns about the semantics of classifying obesity as a disease. … One is I’m not really sure, to our patient population, it matters a tremendous amount if something is a disease versus a condition or a disorder

it becomes harder to talk about personal responsibility.
She says, “I give patients the, you don’t want to be the 40-year-old person in the cripple cart at Walmart, do you?”
Most say no, but some just give me the drop dead stare.

some people do need to step up with their motivation and worry about their lifestyle.

People who have mental health concerns, … ends up being an eating disorder.
There’s developmental delay in kids and adults, and those people are particularly troubling for their families to tackle, and sometimes they go to using food to control their behavior.

there’s a lot of stigma attached to having excess weight.

see also:
https://franzcalvo.wordpress.com/2013/08/12/will-changing-cancer-terminology-change-treatment

http://healthland.time.com/2011/08/16/why-the-new-definition-of-addiction-as-brain-disease-falls-short