Body Mass Index as a Measure of Obesity and Cut-Off for Surgical Eligibility

Key Messages

• This report sought to identify, list, and annotate sources that reported findings regarding the accuracy and/or validity of body mass index as a measure of obesity or a cut-off for surgical eligibility, including reported ethical issues.
• A limited literature search was conducted, and 35 eligible sources were selected and annotated.
• Most studies with relevant findings regarding validity and/or accuracy reported discrepancies between body mass index and other measurements of obesity, or highlighted concerns with current practices that limit surgical eligibility by body mass index for patients who may derive benefit that exceeds the risk of complications.
• Ethical issues reported included stigma, bias (particularly for racialized people), and the potential for body mass index and its use as a cut-off to create or exacerbate disparities in health care access.
• The guidelines identified made recommendations for the use of body mass index cut-off(s) for surgical eligibility, generally intended to limit the risk of post-surgical complications.
• Given the widespread use of body mass index as a measure of obesity and eligibility cut-off for surgical interventions, despite reported discrepancies in accuracy and validity, as well as ethical concerns, further consideration regarding its use is warranted.