So here's an excerpt from an interesting article that showed up in my inbox today. The rest of the article goes on to discredit a study conducted by others who had a different definition of the dependent variable, blah blah, so I omitted that.

My main takeaway from this excerpt is this: you could have a high or low BMI, but what really indicates risk factors for future ill-health are other markers, such as those typically associated with Metabolic Syndrome or Syndrome X.

To me, the most telling line was: "We have previously shown that Stage 0 obese individuals, even with a BMI Of 40 or greater, have virtually no increased risk of dying even over a 20 year period."

Stage 0 is essentially people with no apparent risk factors as shown in the diagram below.

Speaking for my husband, although his BMI is still 28.3 or Overweight, he used to have, and no longer has since the surgery the following markers:

• High blood pressure
• Elevated Glucose
• Elevated cholesterol
• Insulin resistance
• Elevated triglycerides.
• Much less abdominal adiposity since the surgery
• (quit smoking 4 years ago)

​I am so glad he had this surgery!

For me, I have reduced my insulin resistance, abdominal adiposity, and lowered my triglycerides (I didn't have trouble with sugar, cholesterol and BP pre-op)

So if you too have succeeded in getting your labs back to normal on these measures as well as the ones listed below, no matter your BMI, you have decreased your risk of dying significantly. I know we all talk about getting this surgery to save our lives, but these measures make it concrete what risk factors we have now decreased.

Be happy

Which of these markers has improved for you since the surgery? Are you now noticeably healthier than before WLS?

from Dr. Sharma's blog.

Regular readers are quite familiar with the concept of the Edmonton Obesity Staging System, which ranks obese individuals based on how “sick” rather than on just how “big” they are.

To be at Stage 0, obese individuals have to be not only free of any medical abnormalities (e.g. in their labwork) but also have no associated impairment of mental health or quality of life – in other words, Stage 0 = healthy – end of story!

We have previously shown that Stage 0 obese individuals, even with a BMI Of 40 or greater, have virtually no increased risk of dying even over a 20 year period.

Ohhh, thanks! Interesting read!

Great post ! I had surgery 3 weeks ago. I have a home BP monitor because for the last few years I almost always got a borderline high or high reading in medical offices. And it was only normal about 35% of the time that I took it at home (lots of readings in the high 130's over 80 or 85).

Anyway--I haven't lost a ton of weight in the last month (since starting pre-op diet), but I constantly take my BP now because it's so UPLIFTING to get 100% normal readings all the time ! Also--for years my total cholesterol has come back around 215... a recent lab had total cholesterol at 180 with HDL of 62 (yay!).

I don't know where my BMI will settle and --having only been able to drop 10 pounds or so no matter what I did the last 3 years-- I am heartened by my VSG HEALTH results already!

That is so interesting! I was a Stage 0 myself, but had a slightly elevated cholesterol count (not high cholesterol, just elevated), so if I had waited any longer, I would have probably had some issues. That being said - I'd spent the majority of my live as morbidly obese and never had any other problems, so I can see where they were coming from with this! Thanks for posting!

That is surely a nice information. Nowadays BMI is not the only accurate marker. With other tests and analysis providing better results, people are not looking much at BMI.

I am so not a fan of the BMI. It was originally developed between 1830 and 1850 by the Belgian polymath Adolphe Quetelet during the course of developing "social physics", it is defined as the individual's body mass divided by the square of their height. The concept of the BMI is essentially 150-170 years old. In my opinion its use is primarily driven by insurance companies and their Actuaries. Using BMI as a universal tool to predict future health is lazy but it allows the rule makers to place people in nice neat pigeon holes. Since insurance companies use this tool to help predict profit/loss it has become ingrained in our lexicon. It may have some use as a generic guide but not much else. There are better indicators as you have outlined.

As a former strength athlete I will never hit a normal BMI. In fact if I ever reach singe digit bodyfat I will still be considered obese by the BMI table. Measures of health need to be evaluated on a individual basis. Even the US military knows this. When a Soldier/Airman/Marine falls outside the height/weight tables they are not automatically considered overweight. They then have body composition measurements to determine percentage of body fat.

How can BMI be a good indicator of future health when it is not a reliable indicator of current health?

Thanks for your post!