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

This report sought to identify, list, and annotate sources that reported findings regarding the accuracy and/or validity of body mass index (BMI) as a measure of obesity, or as a cut-off for surgical eligibility, including reported ethical issues. Most studies with relevant findings regarding validity and/or accuracy reported discrepancies between BMI and other measurements of obesity, or highlighted concerns with current practices that limit surgical eligibility by BMI for patients who may derive benefit that exceeds the risk of complications. Reported ethical issues included stigma, bias (particularly for racialized people), and the potential for BMI and its use as a cut-off to create or exacerbate disparities in health care access. The identified guidelines made recommendations for the use of BMI cut-offs for surgical eligibility, generally intended to limit the risk of post-surgical complications. Given the widespread use of BMI 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.