Rethinking BMI in Surgery and Health Care – Why a More Comprehensive Approach Matters
For years, Body Mass Index (BMI) has been used as a universal yardstick to assess health, determine risk factors, and even influence eligibility for certain surgeries. But here’s the truth: BMI is flawed. Despite being a widely-adopted metric, it fails to provide a full picture of an individual’s health. Isn’t it time we move beyond a system that oversimplifies such a complex concept?
In this article, I will explore why BMI is problematic, especially in surgical contexts, and why a more comprehensive, personalized approach to health assessment is critical for supporting patients holistically.
What is BMI and Why Has It Been Widely Used?
BMI stands for Body Mass Index, a simple formula used to estimate body fat and assess whether someone is underweight, of normal weight, overweight, or obese.
On paper, it seems straightforward: plug in your height and weight and you get a classification. But from this simplicity emerges its greatest flaw - BMI does not take into account the nuances of individual health, body composition, or lifestyle factors. It’s like trying to summarize a novel in a single word.
For example:
Highly muscular individuals may be classified as overweight, even if they are in excellent health.
Older adults or certain ethnic groups may have different body compositions that BMI doesn’t adequately address.
A person’s metabolic health, genetics, or lifestyle get no consideration in this metric.
The Problem with Using BMI for Surgery Decisions
In surgical contexts, BMI is often used to assess health risks related to anesthesia, post-operative recovery, or complications. While there’s some evidence that higher BMI levels can correlate with increased surgical risks, this blanket approach often ignores critical variables:
Body composition matters - It's the distribution of body fat, muscle, and bone density that often carries more weight in evaluating risk.
Metabolic health - Certain biomarkers like blood pressure, cholesterol, and glucose tolerance provide a far more accurate overview of risk than BMI alone.
Lifestyle factors - Someone with a higher BMI who exercises regularly may have better resilience and healing capacity than someone with a lower BMI who is sedentary.
Relying solely on BMI can inadvertently exclude individuals who are fully capable of undergoing surgery - or worse, stigmatize and discourage them from seeking care.
A More Comprehensive and Patient-Centered Approach
In my practice, and in many progressive health systems, it is commonly agreed that looking beyond BMI leads to better outcomes and empowers patients on their individual journey. Here’s how I approach health comprehensively:
Holistic Evaluations:
Metabolic testing (e.g., blood work) to assess cholesterol, blood sugar, and inflammatory markers.
Lifestyle and activity assessments - How active is the patient? What are their routines and habits?
Mental and Emotional Wellness:
Consideration of the patient’s mental health, stress levels, and their emotional preparedness for surgery and recovery.
Personalized Care Plans:
Tailoring pre-operative and post-operative care based on an individual’s unique needs, such as dietary support, physical therapy, and emotional guidance.
Empowering Patients Through Education:
Helping patients understand that their health is not defined by a number. Offering detailed explanations of evaluation methods allows patients to feel seen, understood, and valued.
By incorporating these factors into surgical decision-making, we’re providing care that’s mindful, equitable, and designed for sustainable outcomes.
Redefining Health Beyond Numbers
At the heart of this shift is a simple but profound idea: health is multifaceted. It’s not limited to weight or size, but it’s defined by how a person feels, functions, and thrives. A single metric should never limit someone’s ability to receive care or take control of their health journey.
Imagine the impact if all health professionals embraced this approach: fewer people discouraged by arbitrary metrics and more individuals empowered to access the care they deserve.
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This article aims to inform and inspire and does not substitute professional medical advice. Always consult with a certified healthcare provider to understand what is best for your unique needs.