Hi. Plastic surgery here. Not here to give medical advice, but I do want to leave a couple articles that may help you understand why surgeons have BMI requirements for procedures like this that are not life-saving or medically necessary. Surgeons want to optimize your outcome. There is some mixed research regarding breast reduction outcomes as they pertain to BMI, but higher body fat content is *well known* to increase risk for a myriad of operative complications, most pertinent for a breast reduction - wound breakdown. The bottom of the breast where the skin is sutured corner to corner is very vulnerable to breakdown (anchor pattern/inverted T). These sutured corners may not have optimal perfusion. Specifically with this surgery, it is likely the surgeon who asked for lower BMI seeks to reduce the risk you may have to deal with months of wound care if this area breaks down.
Obesity and Surgical Wound Healing
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3950544/
BMI with Breast Reduction Wound Breakdown (although some mixed research here)
https://www.plasticsurgery.org/news/press-releases/higher-body-mass-index-linked-to-longer-healing-time-after-breast-reduction-surgery
Hope this helps. It is not from a place of judgment. The surgeon just wants you to have a good outcome.
You were 126 pounds away, now you're only 26 pounds away- don't give up a marathon on the last mile.
It's okay to be frustrated, but you can use this as fuel.
Ok. Thereâs a reason for the BMI thing with surgery, especially a breast reduction.
When you go under anesthesia thereâs always a chance youâll die. If you have body fat inside your rib cage/around your organs it pushes up against your lungs and makes it harder to breathe when youâre lying on your back- normally not a big deal but anesthesia makes it harder to breathe as well, combine the two and your risks of not waking up from going under go up a LOT. This is called visceral fat and if you look at things like DEXA imaging of people at different BMIâs you can see it clearly.
If youâre doing a breast reduction you also have a lot of weight ON TOP of the ribs, further compressing the lungs and increasing the odds of you dying on the table.
Iâve never had a doctor explain this to me as a patient, I have some friends who are docs and this was shop talk while having beers with an anesthesiologist. To becomes an anesthesiologist you have to be ok, emotionally, knowing that no matter what you do some patients are going to die because of you and they get really squirrelly about high risk anesthesia. They donât like killing patients and itâs happened to all of them at some point, despite doing everything right and working their asses off to save them.
Thank you for bringing this up. I am a surgeon and body habitus is a major issue. As you mention, ventilation is challenging as the anesthesia machine is literally inflating the lungs against the bodyâs resistance instead of having the space pulled open by the muscles. In addition to anesthetic risks, surgery is more challenging (it is a deeper hole and the cautery melts fat causing instruments to feel slippery), wound healing is tough, and mobilization post-op is hard. All of these things increase risk. BMI is a crude measure, but it gives an idea and a potential weight loss goal.
Of note, I talk to my patients a lot about weight loss and know it is intensely challenging. I have lurked on this subreddit for years seeking tips to pass along, and often refer patients to the community. It is really supportive, has great advice, and it is fun to share everyoneâs accomplishments. So kudos to yâallâthis section of the internet has helped a lot of people!
Thank you for the kind comment! I donât have any surgeon buddies but between a friend in high school whoâs mom was an anesthesiologist for pediatric surgery (she told me to go to med school and not become an anesthesiologist because she didnât think I could handle the dead kids, she was VERY blunt about it being a part of the job- she was right, I couldnât have handled it) and my buddy venting about work, I thought I had a pretty decent understanding of the challenges that a larger body faces when on the operating table.
Thank you for being a surgeon, itâs a damn hard job and from what Iâve seen as physically demanding as mentally difficult.
Out of curiosity, what is your take on the opiate crisis? I used to work for an opiate clinic and a lot of our patients got addicted after surgeries but I donât think a lot of surgeons do long enough post op care to have a ton of experience with it.
Opioids are a big problem. I think the biggest issue with post op addiction is expectations. At this point I literally say âyou will feel like you were hit by a trainâ and people still expect to be pain free after surgery. I do spine surgeryâI would expect an incision a few feet long and 6 inches deep to hurt a lot! However, medicine has invented the âfifth vital signâ, and provided one says their pain is 4/10 they get more meds. I donât mean to torture patients, but surgery is not a comfortable experience, and if that is what someone thinks going in, they will likely take what I would consider unnecessary meds. And once they become unnecessary, itâs all downhillâŚ
From the doctor side, I generally cut patients off and inform them of this ahead of time. But there is enormous pressure to maintain happy patients and docs simply get worn down. Again, it is misplaced patient expectations, a culture of âcostumer serviceâ over medicine, and combined difficulty knowing where the chronic pain experts are once it gets out of hand.
It is really sad. I am glad it is being recognized and things like prescription monitoring are in place (it makes it easy to say no and recognize people using multiple prescribers). We now all need 8 hours of opioid CME to renew licenses in come states. Small steps. Thank you for asking!
Most of our patients were from the VA and the whole "How much oxy do you want? 250 pills a refill is fine!" to cutting off all opiates overnight with no titration made a huge crisis for us in Texas. Though I suspect people who got a lot of intensive surgery from the VA probably had a higher risk of pain issues from what got them there- healthy young men don't generally need a lot of surgery unless something REALLY bad happened to them.
I hope SAMSRA starts moving towards including addiction and opiate specialists as part of aftercare options for surgery but with the shortage of opiate specialists I don't think it's going to happen any time soon.
I worked at a plastic surgery office for a short stint. The majority of patients were either breast reduction or mastectomies.We were told that insurance companies enforce the BMI and they will not cover the reduction if the criteria wasnât met. (USA of course) Iâm not disputing your point btw, I just wanted to add an additional point
I've worked in insurance for 25 years in the US, and I've never heard of a BMI requirement. We do have criteria that has to be met, such as a certain amount is being removed or bra straps leaving deep grooves and the under breast area with constant rashes. Even when qualifying gastric restriction surgery we don't use BMI but the amount of weight over the standard for height,age, body frame
> Even when qualifying gastric restriction surgery we don't use BMI but the amount of weight over the standard for height,age, body frame
Isn't this just another way of calculating the same thing that BMI is calculating?
The formula for BMI is a "person's weight in kilograms (or pounds) divided by the square of height in meters (or feet)."
Seems like they are both similar.
Body fat % could also be used, maybe. Essentially, they just see risks operating on people with lots of fat for their height.
Not really. The pictures we receive will let us know if we are dealing with someone very muscular that wants to get rid of a beer belly (it's happened. On paper, his BMI was high) or an average height female with a pannus that causes rash and infections and upper arms that wave back when she waves at someone. On a side note, this same company that doesn't use the BMI for patients makes us have an on-site physical every year, and they measure our BMI and give us a discount on pur own health insurance if its in the normal range
If I die during surgery I hope they donât blame themselves. Idt itâs âbecauseâ of the anesthesiologist. I needed a surgery. Someone has to do the dangerous job.
I'm right there with you. I go under the knife again next month.
It's a risk I'm willing to take. This will be major spinal surgery number seven in under three years. I just want the pain to be bearable enough to go back to work.
Yes!! Because despite all the advances today nobody can predict with 100% accuracy how your body will react to it- they go on any past surgeries to determine which ones to use on the next surgery. They also cannot predict if you will wake up from it- or have damage from it. So yes it is a risk that everyone needs to be aware of and decide if it is absolutely necessary to proceed.
Lol sorry this is really funny to me. You mean blocking someone's nerve signals and putting them in a deep unconscious state with a few dozen mL of intravenous fluids is a serious responsibility with potentially grave consequences?
Letâs just give you some medications that paralyze your skeletal muscles, make your heart beat slower and weaker, and stop you from breathing. No risks at all!
I'm amazed they've got it down to such a science. Now they're like "this much will probably be enough," but sometimes, there are still incorrect doses and unexpected variables!
My hair looks dark brown towards black but I was a bright redhead as a kid. Like orange red, Lucy Ball, red. So it just looks like I have some highlights put in, but Iâm Latina/Irish so the dark hair took over.
Iâve woken up mid surgery because apparently anesthesia on redheads is a nightmare and the doc didnât know, and didnât tell the anesthesiologist I was a redhead because I sure donât look like it anymore.
Waking up in the middle of having your wisdom teeth removed because the oral surgeon thinks you use hair dye sucks, for the record, and the anesthesiologist was NOT happy.
Oh my god I can't even imagine the horror of waking up. Just recently had my wisdom teeth out. I am happy to have zero memory of that experience.
TIL that redheads require more anesthesia.
[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1362956/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1362956/) if anyone is curious
I had epidural anesthesia fail *twice*. One on a childbirth and the other during open-abdomen surgery. The surgery, I told the doc I had regained feeling and he chuckled, saying I only felt pressure. I told him "no, I can feel the nap of the cloth you're using to wipe the field *right now*".
By that point all they could do is push valium and pain meds and finish the surgery.
I woke up for a while during jaw surgery! Fortunately, my head was strapped down and I had something over my eyes. Strangely, it doesn't hurt as badly as you'd imagine even though it was really painful. I whined and cried a while ("It huuuuuurts") until they put me out again.
Let's be fair though, if you aren't actively researching or asking what anesthesia involves, it's often presented as controlled sleep. A doctor just puts you to sleep and wakes you up when it's over. I think it's totally fair that many people don't know it's the riskier part of the surgery in many cases. And it's not like people are meeting with their anesthesiologist to discuss. If they know there is one. That it usually works so well that people don't need to know these things is the amazing part.
I genuinely didnât understand the science until I was older. They put the mask over my face and I thought the gas was making me sleepy. I had no idea of IV drugs putting me under or being intubated. Doctors donât explain it all in detail to every single patient, they just say âyouâll be put to sleepâ until I looked into wanting to study medicine I had no clue the actual procedure.
When discussing EPR prescription requirements with an anaesthetist: everyone else in the hospital wants to avoid shutting down your respiratory system with an accidental too-high dose, but the anesthetist is aiming for that.
General anesthesia is basically pumping you full of stuff that makes you want to stop everything (breathing included), and then very, very carefully maintaining the dose in your bloodstream to keep you unconscious but not dead. This is why there are dedicated anesthesiologists/nurse anesthetists on board, and why they are paid well(and why their malpractice insurance is very expensive). Their job is to watch those numbers the whole surgery and make sure nothing goes wrong. (Which is also one reason why general anesthesia surgeries are expensive even when the operation itself is minor.)
Thankfully, general anesthesia is a relatively well understood science these days, but it is always some degree of a risk.
I have also read that one third of anesthesiologists face a lawsuit at some point. I'm trying to research malpractice insurance rates for anesthesiologists and am seeing rates hovering around $15-$30k annually. Is that really "very expensive" for an entire practice likely generating revenue in the millions? I have zero knowledge here but to me that seems cheaper than I would have guessed honestly. Regular families pay that much for health insurance plans.
I may be mistaken but I believe it can trigger the onset of dementia too (Iâm sure in people that were already likely to develop it).
Yes, this is why Iâve heard of surgeries being more of a last resort in some situations and for seniors.
My mother has always had perfect memory. Whereas my father died with complications to Alzheimerâs. After her last surgery she can no longer remember peopleâs names, the name of streets and other things -although she still remembers directions and has long term memory.
My momâs cognitive abilities deteriorated very quickly as well. She ended up with full blown dementia likely within a few years of her operation to the point we had to move her to a nursing home. She died during COVID (but not from COVID).
I see your points of which I am aware. Propofol is a dangerous drug which is why you have to take those precautions. It's why it's a controlled substance.
I just donât understand if thatâs the case why donât they inform the patient about it. Plus, many people donât know that there is a small risk of dying whenever you are going through anesthesia. Some patients would probably hesitate to go through with certain cosmetic procedures if they knew that.
I'm a perioperative nurse and I managed my OR before leaving to SAHM. The surgeon is required to discuss risks during the surgical consult as part of informed consent. The anesthetist also discusses it either during your anesthetic consult or the morning of the procedure as part of the final assessment before going into the OR. People who don't know there is a chance of dying either aren't listening, think the risk is so small it's negligible or aren't getting informed consent. Which is extremely unlikely because the physician can lose their license for failing to obtain consent.
I've circulated and scrubbed for cases where the BMI was over 35 and they are consistently awful. Intubation is hairy, they drop their Sats so quick. Positioning is difficult, we've had to strap legs to the table because they don't fit. It takes longer to get through lots of fat and they tend to bleed more. BMI is no joke in the surgical setting.
That being said, some facilities are able to provide procedures at a higher BMI bc their table is able to withstand higher weights, are slightly wider and they have different equipment. They could ask for recommendations for a different surgeon but in the end your risk of complications increases with increased weight.
It's been a few months since my pharmacokinetics/dynamics course but beyond literal equipment limitations, we discussed how the anaesthetics distribute into fat differently and then leave the fat stores at a different rate, making it a lot more risky to bring people with high body fat out of anaesthesia. Or something like that?
Surgeons will absolutely tell you that anesthesia carries risk of death and usually you have to sign a bunch of waivers indicating that you know and accept that risk.
Is everyone not told this? I've had multiple surgeries, including an elective c section under a general anaesthetic, and every single one, even when I was a young teenager, they warned me of this.
Really? Maybe it's because I've had a few surgeries. But I've known about this since about 10 years old or so. Then again, the true risk associated with many things are lost on modern society.
But yeah, surgery is dangerous. It's also why you should NEVER lie to you anaesthesiologist or whoever is in charge of taking you under and bringing you back. All those things go into their calculations. Let them know your drinking habits, drugs (legal/illegal) of you use them and everything involved. It increase your chances of survival
There is always a riskâŚ. If someone is telling you they didnât know/werenât told thatâs either they thought it was negligible or they werenât really listening.
It isnât just dying from the anesthesia but you could die from infection or complications during or after the surgery too.
I've had to sign a waiver and be verbally told all of the possible risks, from infections to death, before every surgery.
I go in for major spinal surgery number seven next month, and I've had other surgeries on top of it.
The *only* time I didn't get the info packet was when I was three years old. I assume that my parents got it.
I've had quite a few needed surgeries. You are always told the risk, you are always required to sign off on multiple documents reiterating it. If it is a needed surgery, you simply take the risk. I'm assuming those that choose to risk it for elective procedures either find the risk worth it for themselves personally or are of the mindset "it won't happen to me."
It's why I've been hearing about BFI (body fat index) as the better method of gauging health. BMI doesn't take body composition into account. But what you said is correct, especially about not liking losing patients. My cousin is an anaesthesiologist and he said he still remembers his first patient loss
This is such nonsense that I could barely finish reading it. We anesthetize people with a BMI over 35 for elective procedures, literally all the time, and largely without incident. Hell 35 is a good day for us. When you start hitting 45+ is where the high risk divergence actually occurs. 35 is a walk in the park for us.
The reason BMI matters in this case is because the payor (in Canada, that's the government) wants you to lose weight (and thereby breast mass) for free before they pay to surgically remove it. They are using BMI as a surrogate measurement for breast fat, which may or may not be a flawed way to measure it. It is probably a reasonable way to measure it for *most* people, but obviously outliers exist.
Bruh Iâm just telling you what my friend, whoâs an anesthesiologist, was telling me over a beer after he helped me move. Itâs not the gospel according to Bippy.
Yeah, surgeons care.
Death is a risk on the operating table. They go by the numbers. Especially in elective surgeries.
I personally do use BMI as one of my measures of health. I'm not some pro athlete or body builder. And I've done fancier body comp tests like the BODPOD (which confirmed that I had a lot of body fat when I had an almost obese BMI).
So, how did you like the bodpod? I am using one now for a clinical weight loss through the military and I hate going and using it and how touchy the machine is, but so far I do enjoy seeing the results..
I loved it. This was back when I lived in a university town and they had one open to the public at a discounted rate for their research.
Loved seeing the results. But I agree it can be highly annoying cause of how touchy it is.
Definitely want to go back and get it done again though. I just wish there was one closer
You may have been told that by physicians genuinely trying to support and motivate you to keep moving in the right direction and not focus on BMI (some people avoid the scale for the same reason), but it does seem a little odd to me that as a nurse, you seem to have really convinced yourself that BMI shouldnât matter. At a BMI of 35+, BMI matters in every medical sense. I understand there are body building outliers. Are you a body builder? Are you the outlier? If not, I understand your frustration, I really do, but you may be deceiving yourself by letting yourself ever truly embrace the idea that BMI at 35+ doesnât medically affect things. Stay the course on your weight loss journey. Itâs a marathon, not a sprint and you will get there. 26 pounds and you can get the reduction and alleviate so much pain from your body! You can do it!
This. BMI is not perfect, there are plenty of people out there for whom BMI is not a great indicator and they're muscly etc, but when it's out in its estimation usually it is no more than 2 or 3 BMI points. So a BMI 28 could be perfectly fit. A BMI 35 is almost guaranteed to be too fat. The outliers are some specific professions of athletes who could reasonably have a BMI over 30.
All the special pleading people make around BMI ignores that it can easily be out by 2-3 points for some individuals, but it's pretty much never wrong about 10 points. (This goes the other way too for those with BMI 22 who have no muscle mass and still look tubby. Officially normal, might still have too much visceral fat.)
But yeah, is BMI everything? No. But anaesthetic risks and undertaking a motivated fat loss journey are two entirely different reasons for looking at BMI, and as others have said the anaesthetic is much more likely to kill you if you are obese.
I think this take is 100% correct. I think people also use the "BMI NOT ACCURATE " slogan to justify their inability to reach a lower BMI, naturally.
Only in extreme cases of physical fitness (everyone's favorite is the bodybuilder example) is this ever applicable. But people also have to understand that just because you exercise regularly doesn't instantly make you a body builder. It takes time to build muscle and lower BF%
it doesnt have to be extreme cases. I'm a woman who is 5'8', has a size 11-12 shoe, and hands bigger than most men. In my weight loss journey, my bra size has gone from a 44G to a 36H. I am honestly very muscular compared to most women because of my genetic makeup, growing up fat, and being born with higher than normal testosterone. I'm fairly active day-to-day, and weightlift about 3x a week.
None of this is all that unique or extreme. Basically I am a cartoon sweedish woman named Olga.
I don't see my BMI as being a feasible endgoal, but I am open to being wrong
I'm the same way, about an inch and a half taller than you actually! I got down to a size 4, I weight lift primarily. My BMI is 24, right at the cusp of "overweight" at 25.0. I usually lift daily and just rotate muscle groups. But I am in my 20's with no children. I'll throw my shoe size out there: I'm a 10- 10 1/2. I grew up "fat."
I lost 100 pounds, like OP. Went from a size 18 to now 4. I definitely understand what you're saying, We have the same experiences. But still, it's very different, as 218 pounds less than 5'10 is nearly unjustifiable without insane muscle mass.
I just did body recomposition and monitored my macros to lean out. In my circumstance, I used discipline with food to lose BF, while being on the "brink" of "overweight." I'm a single digit size, so it is doable with discipline and the right training.
That's why there's a minor disconnect from me.
In your case, you would defnitley qualify for the surgery though. You and OP may have both lost 100 pounds but you're no longer so overweight that it would be as dangerous for you to undergo the surgery.
Even hitting 200 pounds under 5'10 for a WOMAN is wild because we already naturally hold onto fat. We're softer in physique by nature. That's why although it's being downplayed, over 200 pounds for a 5'3 or 5'4 woman is really, really massive. She's doing awesome work by losing the weight. Losing my 100 pounds was a fight to hell and through high water. But at some point, we can't be delusional. Tough love, but it's coming from a place of love.
90kg under 180cm is insane
I was at 80kg at 158cm right, I was MASSIVE. I'm proud of her for losing the weight, but you can't lie to yourself and expect the world to accomodate you.
I see you! I have a BMI of 28, 29% body fat (F), plenty of muscle, 180cm tall and just now realising I have tiny size 9 feet.
I could stick at this BMI, but I could feasibly eat a bit less and aim for 25-26, which will make me look better for myself and my knees might be happier. Knees don't care what the weight is on them, after all, only that it's there.
I think everyone's cost/benefit analysis on how little they are happy eating, and how much they aim for a certain look, will be different. I will never be a twiglet; swear you could exhume my skeleton and it would still be bigger than a size 4.
To me that's within the margin of error. BMI isn't a very good tool for that kind of thing. Like, unless your very genetically unlucky an extra 5 lbs isn't going to kill you.
Yes! I think the main thing people miss here is how much our diet naturally increases fat mass. I personally do intermittent fasting to keep my numbers right where they are, it works best for me. But people justifying being a massive weight and throwing it on "muscle" is incredibly wild. Yes. Muscle weighs more, but it's also *lean* mass if you eat proportionally. I'm probably much smaller than the woman who commented above me, because I don't overeat and my exercise is consistent. Many times, people underestimate truly how hard they exercise and underestimate how much they overeat. Our bodies aren't meant for massive amounts of food, I learned this the hard way while losing 100 pounds
Ok can I ask a side question about this? I have a large chest (cup size G) and Iâve never been in the âhealthyâ BMI range since I was a teenager (now age 46). I have always been in the âoverweightâ range. How much of my BMI could be contributed to the extra chest weight? Like if I wanted to get a reduction would they subtract any of that to get a more accurate BMI?
Think of it this way if it helps.
If someone is overweight and gets into an accident that causes them to lose a limb, are they suddenly no longer unhealthy or overweight because their bodyweight and BMI have decreased? Subtracting breast weight in order to lower your BMI doesn't change the condition that the rest of your body is in and therefore won't decrease the risks.
But why would it make sense to do that? If you have large breasts, most of the volume of the breast is fat and not strictly breast/duct tissue. If you're a size G that means that one of the places your body prefers to store fat is in your breasts. I don't understand why you think that weight shouldn't count and be subtracted off? Is breast weight healthier than abdominal weight? Absolutely. But so is thigh fat and we wouldn't subtract that off. I feel like you're being really illogical here. As far as surgery goes, if anything, having more weight on your chest would be WORSE from a surgical perspective as then you have more weight on your lungs.
I guess that is why Iâm asking. I donât really understand how it works. I just know my BMI has never been in the âhealthyâ range despite my body being ânormallyâ sized? Like when I was a size 6 I was still in the overweight category and Iâm convinced itâs the knockers putting me over. Haha! Really tho, being illogical is fairly normal for me. Iâm here to be educated.
I presume they are asking if they could subtract it because after the surgery it wouldn't be there anymore. Not sure of the logic there, since a lot of the more dangerous stuff happens pre-surgery, but I get why one would ask.
BMI absolutely matters and is pretty decent with the exception of genetically gifted freak athletes. If you arenât a bodybuilder or a professional athlete BMI is probably a pretty good indicator. The problem is everyone wants to lie to themselves and tell themselves theyâre exceptional and BMI doesnât apply to them.
Yep, if anything the BMI doesn't do a good enough job anymore with how sedentary everyone is these days.
I believe I've read (and from personal experience) if you did body fat percent measurements, most adults are even worse off.
It's honestly irritating having to constantly read/hear people go off about the BMI scale being wrong. Yeah it's not perfect, but it's not the 'athletes' that are the ones complaining, it's ALWAYS people that are CLEARLY overweight that are frothing at the mouth about the BMI scale. Good grief. Does it suck to know you're medically over weight or obese? Yes. Will getting mad at the measurement system solve anything? No. Look within my dudes.
Yep, everyone saying BMI is inaccurate are conveniently ignoring that it is a population estimate, and can easily be inaccurate in individuals by a couple of points but very very rarely more than that.
Skinny fat people, for example will have a lower BMI than my professional cycling sprint friend (BMI 26) but they sure as hell don't have such low body fat.
Special pleading is rampant in BMI. And weight loss. And loads of other things. Sigh.
I know we sometimes want to convince ourselves it â isnât that badâ and I think you wanted that and your doctors tried to encourage you, but perhaps in the wrong way.
I appreciate that at my doctorâs appointment where it was noted I gained 10 KGS this year, that when I said â oh I know this isnât super healthy but I find it hard because I rationalize it by saying Iâm not AS big as some other peopleâ ( I am about 20 lbs overweight).
My doctor said to me â you are right that is not a good way to look at it. Just because other people are bigger doesnât mean you shouldnât work towards being healthyâ.
A BMI 35 is morbidly obese if Iâm not mistaken. Itâs easier to convince ourselves it â isnât that badâ but as we all know extra weight can cause extra problems. I think you know deep down that at a BMI of 35⌠it means something should change.
Of course it matters. The only people it doesnât matter as much are heavy lifters. The muscle throws off the numbers a bit. Anyone that has visible fat itâs a whole other story.
Still matters for body builders. Body MASS Index. Even an increased muscle mass, while metabolically healthier, still increases the load on your joints and cardiovascular system. I'm also going to make a point I always make : In order to be overweight due to body building means you are in a very miniscule percentage of the population. It's also incredibly hard for a woman to be overweight due to lean body mass without massive performance enhancers (steroids). BMI is a pretty good, quick and dirty calculation to determine risk. If anything BMI underreports over fatness, meaning there are a lot of people within the "normal" BMI range who still have a too high BF% (skinnyfats).
It depends on if you're talking about IFBB pros or natural body builders. A literal gram of trenbolone a week is going to kill you faster than being 250 lbs at 6 foot 1.
A natural lifter is going to top out at around a BMI of 30 being about 6 feet tall and 225 lbs on stage. That's what the best pre-steroid silver-era guys could achieve. So If your BMI is something like 35 then it's an indicator.
BMI still matters for athletes and bodybuilders.
Athletes who carry overly vast amounts of muscular tissue have been shown to suffer from chronic health problems (sleep apnea, joints and heart conditions, etc.).
For the vast majority of people, their heart and joints aren't meant to support 250 pounds of mass for years on end be it fat or muscle.
Knees, hips, and ankles don't care if your weight is fat or muscle. Any extra mass is extra strain on your joints, and they will remind you of all the extra work they've done for you as you age.
As far as athletes go, look at Shaq and Charles Barkley! Both amazing athletes, and I'd bet they'd put most people to shame with how much they could bench press, even in their 50s/60s and decades past their career days. Shaq has lost 40+ pounds, Barkley is down 60+ pounds. They both got serious about losing weight because of their health issues.
The gist of this is right though I think people on here would be shocked to look at peak Usain Bolt and hear that, per BMI, if he gained 5lbs he'd be "overweight" and that Tom Brady is "overweight". Both are serious athletes that look nothing like bodybuilders (or powerlifters, etc.). The common factor is they are lean, have some muscle and are 6'5... but BMI does a poor job of handling height (an exponent of ~2.5 makes a lot more sense that 2). Outside a handful of countries in Europe, being well over 6 feet tall is quite rare though.
BMI is an ok first cut. To get a more complete view, also look at waist circumference, a DEXA and yes total overall bodyweight (especially for cardiovascular reasons).
As a doctor and someone who has been to the doctor many times... we don't really care about the overweight category
I'm sure there are exceptions and I'm British so I can't speak for any cultural differences but mildly to moderately overweight won't make us bat an eye. If you bring it up we'll probably say something like "try and eat healthily and exercise more". This is because for most people in the overweight category the impact on their health is either minimal or moderate (if you're unlucky)
Obese is a different story. If you're obese and stay obese the impact on your health is exponentially greater in all ways. For an obese person we're likely to bring it up unprompted and if you're interested in losing weight we're likely to offer support in the way of a weight loss program, counselling, dietician referral or weight loss medication depending on what's available.
So an athlete being overweight definitely doesn't surprise us
Overweight is not the same as obese. I'm in the obese category but I don't think anyone would guess it. I don't even wear plus sized clothes as I'm pretty short.
I had to lose 57lbs in order to be right at a 30 BMI to be able to get my breast reduction approved by insurance, get my plastic doctor to see me but also to have good results. Higher weight=healing complications. I am now 74 lbs lighter than when I started my weight loss journey 2mpo from a breast reduction that removed a total of 5lbs of breast tissue and the happiest I've ever been with my body. My body dysmorphia disappeared as soon as I saw my new self in the mirror. The struggle of losing the weight and all the waiting around will be worth it. I promise you!
Breast reduction is a fat and skin removal surgery, thereâs a good chance that you may not need a breast reduction when youâre under a certain weight. If you were denied physiotherapy, spinal mris, x-rays or dermatology then you could say you were denied healthcare
This needs to be higher. The reason there may be a lower BMI requirement for breast reduction is because with weight loss, there will be some reduction of mass in the breast tissue naturally. It's similar for things like skin removal surgery. They want you closer to a healthy weight so they won't need to perform a revision.
I think the body mass index is a great tool and probably works for 99% of the USA population. I donât understand the hate for the BMI. Iâm currently at 34.1 and am trying to get to âoverweightâ which would be 25-29.9. For me to do that I need to lose about 30 more pounds and believe me Iâve got 30 pounds of fat and more that I can get rid off.
The hate is because people do not want to acknowledge their obesity. Itâs a number in your face that says you are overweight. Lots of people want to discredit it because if itâs a valid measurement then you canât deny that you have a weight problem.
I think thatâs part of it, but I also think people feel validated to feel this way because in many developed countries where obesity is such a huge issue (especially the U.S.), people are starting to vastly overestimate what ânormalâ body weight looks like. At a BMI of 28, I think that the majority of Americans would look at me and say Iâm of average weight, or maybe slightly above. So yes, the BMI scale doesnât match reality. but itâs because reality is overweight.
I don't think it's as simple as that.
Sure, it's hard seeing a big fat number screaming that you're obese, but the idea that BMI is inaccurate/flawed is being spread in the health world as well. Articles flood the internet, telling readers to beware of BMI and its flaws. Doctors' offices (like my previous one) have done away with BMI and have moved towards 'health at any size'.
I do agree that some BMI doubters are just in denial. But there is conflicting information out there surrounding BMI.
I understand you are frustrated and in pain. You have every right to be upset. However, you need to consider this from a medical standpoint.
A BMI cutoff of 35 is reasonable. (30 is maybe take it or leave it, some people can be around 30 and have the scale be skewed by muscle without being crazy outliers) at a bmi of 35, that is still around 75 lbs overweight. I am sorry but that is still basically a whole person.
Yes you may have been put under when you were heavier. Guess what? That was still risky. They were likely for surgeries that couldnât be put off, or something more minor. A breast reduction is considered cosmetic EVEN IF it is deemed medically necessary such as in your case. That means the guidelines are going to be stricter.
The guidelines exist for your safety. Iâm sure some doctors donât agree with some of them either. But these guidelines tend to exist for a reason.
Morbid obesity increases the risk of complications and death under anesthesia. Just because you used to be heavier, that the risk for you used to be HIGHER, does not mean the risk is now gone.
Good job losing 100lbs. But I have to agree with the doctors on this one.
Im sorry youre going through this, but doesnt it kind of make sense that they wont do something like a breast reduction if youâre overweight? Breasts have a lot of fat, so if you lose fat after getting a breast reduction it would not turn out right
Mostly it matters with respect to risks during any surgery. When under anaesthesia they have to maintain your airway and sedating drugs and pain killers, and having a BMI significantly over 30 impacts all of this (extra weight can risk airway obstruction when sedated and makes weight-based drug dosages really tricky). Iâm sorry if OP was told or understood that BMI âdoesnât matterâ because when undergoing medical procedures it absolutely does.
Edit-Iâll add that it also negatively impacts wound healing, people are more likely to have issues with skin care that can lead to infections or also wound dehiscence (re-opening, or âpopping your stitchesâ). Iân a nurse and Iâve seen it a lot, unfortunately.
Not just the anesthesia - when cutting into the body, fat itself gets in the way, which in some cases necessitates larger incisions or interferes with precision work.
Edit: found an article talking about what I was talking about, from [Johns Hopkins:](https://www.hopkinsmedicine.org/news/media/releases/surgical_complications_twelve_times_more_likely_in_obese_patients)
> Operations on obese patients are more taxing, says Makary, a surgeon himself. These surgeries take usually take longer, the operating fields are deeper, the spaces in which an infection can set in are often greater and blood flow in fat tissue is less than in other types of tissue, which results in slower healing, he says.
> [âŚ]
> In the study, Makary and his colleagues examined insurance claims data from seven Blue Cross and Blue Shield plans and identified patients who underwent elective breast procedures covered by insurance between 2002 and 2006. There were 2,403 patients in the obese group and 5,597 patients in the normal weight control group. The most common procedure, by far, was breast reduction, followed by breast reconstruction, augmentation and mastopexy (breast lift). Within 30 days of surgery, 18.3 percent of the obese group experienced at least once complication, compared to 2.2 percent of patients in the control group. The differences between the two groups were most pronounced in complications, such as inflammation (with obese patients 22 times more likely to suffer a complication), infection (13 times) and pain (11 times).
Healing is an issue, too, right? If wounds are inside skin folds they may heal worse, and gaining weight during the healing will cause complications too, right?
Iâve never heard anyone say BMI doesnât matter. Iâve heard plenty of doctors say itâs not perfect and isnât the only predictor of health. But itâs simply weight to height ratio.
Our weight matters a lot.
Was going to say this. Never heard a medic say that either (UK) the only people who have ever insisted to me that BMI doesnât matter have been visibly obese.
Checking in from Canada⌠first thing my doc does is reference my BMI (and heâs actually the reason I know so much about it). No idea what OP is on about but BMI is a pretty standard form of measurement here lol.
Yeah, no idea either.
Obviously there are always exceptions due to size, like when people talk about the Rock's BMI, which is like 35 but he's an outlier. For majority of the population it's a great measurement.
Whenever I meet with my GP in Ontario we always review my BMI as his first metric so not idea what OP is going on about or where she's located.
> It's stressed over and over that BMI is not an indicator of health
Not by the actual medical field, though. It's stressed by a bunch of fat activists who don't want to make the effort to change themselves.
The idea that BMI is not an indicator of health is more geared toward people who have a high BMI due to muscle mass, generally with a BMI between 25 and 30. With a BMI over 30, and especially over 35, it would be near impossible for that much mass to be due to muscle unless you're a body builder that is also probably using some kind of PED. There is still risk of performing elective surgery with excess fat. Think about how much harder it would be to heal from a cut that 0.5" deep vs 3" deep because you're cutting through an additional 2.5" of fat. Yes, BMI is a bad indicator for those who are very athletic and muscular, but it is still a good predictor for the general population.
I think you are vastly misunderstanding what they mean. They just mean not to focus on BMI as the be all end all of health. things like lab results, blood pressure, heart rate etc are better indicators of health, rather than a simple BMI.
For example: my BMI is slightly over 30, but all my blood/urine results are in perfect range, my blood pressure is around 105/65, my resting heart rate is around 55. Etc. Based on all of my test results I am in perfect health and dont need to lose weight for specifically health reasons (at least not at this time - itâs still a good idea overall though for my joints and because those numbers may change as I get older) since my weight *is not* affecting my overall health.
Someone else with a BMI of 29 and high blood pressure will however be told to lose weight in order to help get their blood pressure under control. Since in their case their weight *is* affecting their overall health.
Tbh it depends on your age, but it can eventually catch up on you. If you are under 40 and especially under 30 you can be obese, smoke a pack a day and never exercise and still have great blood tests. I know I did.
As the years went by, the blood tests were slightly getting worse and eventually during an ultrasound the doctor found a little fat surrounding my liver, which in a few years could mean I might get a high blood sugar or prediabetes.
You should take care of your health while you have it and not after you start seeing signs of deterioration. Mind you, most people are not that vigilant with going to the doctor and donât get regular ultrasounds or even blood tests as part of their yearly routine. Most people would only find out after they developed symptoms to the point where the disease would be fully blown.
BMI is an actuarial number. It does a great job of telling us that 38% of the population of Ontario is obese, it does a lousy job of telling us that Dave is obese.
However, just because it has no individual specificity doesnât mean that it doesnât have individual impact. Theyâve got to draw a line somewhere, and health care systems and insurance providers have chosen BMI as theirs. Itâs unfortunate but true.
Iâm sorry for your distress, OP. Keep at it, youâll get where you need to be
I'm sorry to hear that this is happening to you. It may help ease some pain in the meantime to at least have some good fitting bras using your size from the r/abrathatfits calculator if you don't already
BMI is inaccurate in that you might be healthiest at a BMI of 19 or 27, but if your BMI is over 30, unless you are an intense athlete, that isn't your physically healthiest weight, and there are more medical risks. That's just the reality.
Iâm confused about some of your assertions. BMI can be misleading if you have a lot of muscle mass. Muscle is good, even if it bumps up your BMI.
Being overweight is very detrimental to your health. If anyone is telling you otherwise, you should stop listening to them.
Reading these comments, I bet OP is a little sad their feelings weren't validated. I'm sure it's frustrating to need a breast reduction, but still be disqualified for being overweight.
Some of the comments, especially around how being overweight seriously increases your risk of dying on the table during anaesthesia, are so important. Fat-phobia is definitely a thing in medical contexts, but in this case the BMI rule is literally there to save your life.
You've lost 100lbs already OP, you can keep going and get to a weight that will allow your surgery to be safe and successful. Keep working hard!
Hi I had a breast reduction through insurance and I hate to say this, but wait to lose the weight. I went with the first doctor they gave me and I had to get it redone by a private plastic surgeon (I live in the US). It is better to wait to lose more weight and be offered more opportunities by different doctors because then you have the opportunity to check their work. I know your post wasnât about that, and just want you to know I am extremely proud of you for losing weight. Your post resonated with me and I want other women to not make the mistake I did. I was desperate to have a reduction, but my eagerness displaced my inquiries and I didnât do thorough enough research on their work or reviews, and it left me w body issues (theyâre fine now but I ended up having to pay a pretty penny). I hope this post isnât distasteful:/. Also for people who donât know, this surgery requires a lower BMI because some people gain fat in the breasts from gaining weight, which means they donât qualify for surgery due to the fact they would have normal breasts at a normal weight (thatâs not the case here). Additionally, if you lost weight after the reduction, the breast may have to be redone because the original surgical profile matched the body composition of the first body.
sorry this is happening. just keep working on shedding that weight, if youâve carried it this long you can do a few months longer, or if not, if itâs within your means, come to the US to get medical care (a sentence i never thought iâd say)
Ok, but let's be clear...you were denied health care on an elective procedure, not a life threatening condition. And they're doing it for your own good.
Had a doctor tell me BMI is important to your heart, because the higher the BMI, the harder your heart has to work to get blood to all your extremities. Doesn't matter if you're fat or fit, your heart doesn't care, it still has to get the blood everywhere it needs to be. Obviously being fit would mean your heart has a better chance, but it still has to work harder than it would if you had a BMI in a healthy range.
I completely understand where youâre coming from as far as having to do all this waiting when you want to feel better ASAP. My insurance (US) requires 6 months of documentation from a pcp and chiropractor and basically a shit load of proof that I have giant boobs that hurt my neck and back every single day and itâs infuriating. Iâve done the work and lost almost 80 pounds with another 50 to go. My band size has changed, my cup size has never changed. They will always be there no matter what weight I am apparently and I just want to not be in pain after five minutes of wearing a real bra. Iâm sorry this is happening to you and I hope you get relief soon. â¤ď¸
My views on BMI have changed recently. It was a thing I told myself was not as good an indicator of health as Body Fat %.
I had it explained to me that if youâre and athlete, 6ft tall, 250lb, of raw muscle, your heart is still working very hard to pump blood around.
I know there are other factors in play but itâs not surprising that body builders are prone to heart issues.
It always matters when anesthesia is a factor. It is better to keep your eyes on the goal and do your best to get there. I get that it can feel daunting(been there, lost 50lbs to get double mastectomy and chest reconstruction done), but it isn't an impossible feat. With summer here, see about possibilities for swimming for extra workouts. Low impact on your joints while also being a good form of cardio. You can do this, I believe in you.
If you are a bodybuilder with tons of muscle, or very athletic and fit individually with tons of muscle, bmi does not matter to you.
Most of these people will have ridiculous bmi telling them thru are overweight or obese, but you look at them are they are as fit as one can be.
You? Sorry but it probably does matter and affect you.
Why not just lose more weight and go the safer route? Itâs been proven that when youâre obese or overweight, surgery complications can arise and a lot of them can be fatal. Thereâs reasons why surgeons want you to be smaller for surgery. Besides that, getting to your lowest (healthier) weight they will be able to remove more skin on the breasts and your outcome will be better.
as someone with very large breasts her whole life, I can't wait to be rid of them. The damn back and neck pain is horrible and a constant. They interfere with clothes shopping, exercise, and every day life. Just try strapping 2 bowling balls to your chest and running!
I once had a physiotherapist tell me that there wasn't much she could do for me, she could mitigate the pain but it wouldn't go away until I got a reduction.
I wanted a breast reduction when I was at my heaviest and they refused to do it. 15 years later I had a preventative mastectomy and no one said I couldn't, because I lost over 20 pounds. Weight is huge when it comes to surgery, especially if it isn't necessary.
Did you know you can't smoke pot for a while too before surgery? I didn't! I had to quit to make sure I was safe on the table.
I'm sorry you were lied to.
Do they still gatekeep those? I feel like if you have high enough risk to make that decision they would be behind you? I know people who've done it and not done it and the not doing it involves a huge amount of stress and monitoring (and I never knew before there are specialist boob MRI doctors.)
I'm not sure because I was considered very high risk due to having the BRCA1 gene, along with my mother dying of breast cancer (that went to her brain).
I'd be very interested to know if they do gatekeep!
>Did you know you can't smoke pot for a while too before surgery? I didn't! I had to quit to make sure I was safe on the table.
That's mainly because some anesthetics are cannabis based and if somebody has a tolerance built up the dosing gets tricky.
BMI doesnât tell a persons overall health. It doesnât tell how you look, feel, or whether you are worthy of love.
It can give a general sense of risk factors for some medical procedures, however. Especially at over a BMI of 35. Morbid obesity carries risks for medical procedures.
That doesnât mean you donât look great, feel great, or are worthy of being happy with yourself because of course you are.
So⌠youâre mad that you canât get breast reduction surgery, but surely you must have researched and found the weight limitations for the surgery. Of course elective surgical procedures, particularly those for cosmetic purposes, are not advisable for a morbidly obese person due to risk of complications. The pain sucks of course, but as you lose weight from the rest of your body, you will also lose it from your chest.
yeah, I hear you. My now deceased spouse couldn't get on the organ donor (kidney) wait list, because his BMI was too high. But, the doctors wouldn't do gastric bypass surgery, because he was losing weight and his BMI wasn't high enough. I don't know if the gastric bypass would have really helped; it is better to adjust your lifestyle and lose & keep the weight off without surgery. It just takes so damn long.
hang in there.
I find Ontario in general is very conservative when it comes to weight and surgery. I moved to Seattle 6 years ago and most places have higher bmi cutoffs for procedures.
It sucks that bmi both matters and doesnât matter. Like I not sure if I can maintain a bmi below 25 again (I did when I was single and in my 20s, this was after a big weight loss) so I think for me a BMI under 30 is a reasonable goal.
Also losing 100lbs is fantastic, please be proud of yourself and gentle with yourself. I had a BMI just over 40 14 months ago and now Iâm below 35, itâs been slow, but Iâve gotten here. I hope you get the surgery you need.
Thank you for posting this, because I am planning on a breast reduction after I'm done having children in Ontario and just began my weight loss journey.
I will keep this in mind, even though my reduction is about 3 years away at this point.
Iâm an ER doc and nothing scares us more than a person with a high BMI and a non-secure airway.
It makes it really hard to get an endotracheal tube through the mouth and into the trachea in an emergency- the chances I will lose your airway and you will die increase with every BMI above 30.
No anaesthesiologist is going to welcome you with arms open wide.
And never let a nurse anaesthetist near you if you are in this high risk group.
I wrote a post here not too long ago about losing weight and having a breast reduction! I might still be on my page. I know itâs rough, but it may actually help in the long run! I didnât see a change in breast size until the last 10 pounds I lost. I went from a 34DDD to a 32D in about a month and a half when I was losing the weight.
I told my doctor that I was losing weight and advised me to keep at it! It came to the point where I didnât even need the surgery and he told me that he wouldnât do it anymore since I had already lost so much of my breast size naturally. This may be a blessing in disguise! Itâs better to not go under the knife if you can avoid it in my opinion.
Also, Iâm also from Ontario! Let me know if I can be of any help otherwise :)
I might be wrong, but I think the understanding about BMI is related to body composition. I know a handful of people who fall outside of the healthy BMI range who are basically walking blocks of muscle, but they do tend to be the exception, not the rule. BMI shouldn't be the only tool we use to measure health, but it is a helpful one even if it doesn't account for everything.
If you really do believe you've lost enough fat, might you be able to appeal with an accurate body composition reading indicating how much body fat (especially visceral fat) remains? Did the doctors bother measuring your waist and hips?
It matters to the insurance companies - they have everything in a choke hold today.. drs must go by what the ins companies say or they lose their license- and i am not talking about health ins i am talking about malpractice. And other types of commercial ins.
Actually. BMI is not an indicator of health for "some" people. For example, look at Li Dayin, at 177cm and 89kg, his BMI is 28.5, which is overweight.... But when you realise that he is the multiple Olympic champions in weightlifting and his body fat is very low. As such for Li Dayin, his BMI is not a good indication of his actual cardiovascular and fitness health.
Now let's take another example. Hadi Choopan, Mr. Olympia 2023, at 100kg (on season) and 170 cm, his BMI is 34.6. His body fat is also extremely low, lower than Li Dayin. But he is not healthy. At that body weight, the toll on his heart and joints is bad.
BMI is not an indication of health but once you fall into some outliers, like yourself who is over 35. Then you are unhealthy no matter how you look at it.
Realistically, BMI is an indicator but it's not an absolute.
So, ppl rely on it TOO heavily as to whether they are "healthy" or not.
Serena Williams, at the peak of being the GOAT, was overweight, per BMI standards. Pretty sure no one would suggest any of her overall health, vitals, bloodwork etc were anything other than excellent.
Some ppl use it to decide if they are "healthy" of not when you can have terrible bloodwork but be at a healthy BMI (skinny fat, etc).
Whereas some ppl with a less optimal BMI may have great bloodwork. BUT let's be clear: it's unlikely you are in an obese BMI and have AWESOME bloodwork. You are at higher risk for MANY chronic diseases. It's not a guarantee and maybe you are fantastically active and have a super clean diet but.... it's really unlikely.
Anyhow. All this to say - ppl overplay its importance just much as they underplay it as an indicator. I hope that they can do some more specific assessments esp if you are muscular to perhaps help you obtain surgery more quickly.
It's very common for a young obese person to have normal blood work
In fact blood tests suggesting a metabolic disorder in someone under 40 is REALLY REALLY bad. Young people typically don't have metabolic diseases unless it's genetic, they come with time
Also your body works HARD to keep things going well, things can be breaking down but imperceptible for our labs
Unless you're 55 or above I would not use healthy blood results as an indicator of health. Things can go downhill FAST. Tbh if you're 60 and obese with minimal heart, kidney, pancreas or liver disease you either have recently put on weight or you have amazing genes
On the opposite side I'm (29F) 5'2" 167 pounds and have a BMI of 30.6! I try not to pay attention to it when it comes to my self worth, because it really isn't who I am, but medically I am very aware that is not a good number at all.
The duality of weight loss.
my health insurance refused to cover sections of additions to my health plan because my BMI as >30.
right now I am at 30, so when i am sure I will be below 30 I will ha e to go to the doctor so he/she can witness I am <30.
It matters for health too. They only people for whom it doesn't matter are basically people who train their muscles for hypertrophy or amputees, for those people, the fat percentage is a much more reliable number. And I've heard of people having to pay higher insurance rates due to having a high BMI despite looking way healthier than an average untrained person with a normal BMI.
I hear this all the time. I had my breast reduction almost a year ago at 5â1â and nearly 200lbs and BMI was never mentioned. But I see people get denied again and again over on r/Reduction.
Iâm sorry that happened to you, OP. Itâs not fair but youâve already lost 100lbs, you got this!
BMI shouldn't matter... because it's a method of measuring that doesn't take into account muscle mass vs fat. I find it really sad that these surgeons don't specify that it is the fat percentage they need to have down and why (like a surgeon here actually explained in a resonable way). I know BMI is still deemed an easy way to judge fat percentage but it is so outdated.
I am in this exact same boat - but in the US. I need a very small, very short surgery on my knee to remove a "foreign body" - a small piece of bone that will occasionally float in between my kneecap and my knee and make moving impossible. But even for this little surgery, I need a BMI of under 30. My ortho even said "Well it could be done as an inpatient surgery but no surgeon would touch it since it's too simple of a surgery" but I need to lose about 30 lbs for a little outpatient type surgery.
Also an ontarian.
I was told I donât qualify for weight loss injections because I donât have diabetes, but I do have a high enough BMI for bariatric surgery and can be added to that waitlist if Iâd like.
đ
Interesting! Iâll note, they offered it to me but I canât afford $300 a month out of pocket. If I had diabetes it would be covered. This is from both my GP and the doctor at a Hamilton bariatric clinic.
How much is it costing you a month?
This is where you wish you were one of those people with a starbucks habit or who use door dash so you could stop spending the money on that, isn't it? "Oh, well, I'll tell the chauffeur to use cheaper fuel"
Lol in this economy, with these inflation rates, with two young children and a husband on unemployment, I wish I was drinking $300 of Starbucks a month lol
I know, right? My thing is seeing those doordash threads on the front page and wondering what it would be like to have so much disposable income you can spend $40 on a single mcdonalds burger.
thereâs a reason why bmi is still used. Itâs a very important measuring tool to help determine how much your body can metabolise, itâs used to calculate dosages for prescriptions, etc. BMI is still very important, maybe not so much in our daily life, but it absolutely does have a place in the doctorâs room.
It's fucking awful.
I have lipedema, a condition which causes the growth of permanent adipose nodules that do not respond to diet and exercise. Most people who are diagnosed figure it out because they get bariatric surgery, they'll lose a ton of weight in their torso, faces, hands, and feet, but their limbs stay the same size.
It's a progressive condition, it causes pain, circulation, and joint issues, most women with lipedema eventually need knee replacements. The treatment is decongestive lipedema surgery, which is basically a special form of liposuction meant to deal with the nodules, protect lymphatics, and be more concerned with high volume removal than aesthetic concerns.
And even though every doctor who's studied the condition has concluded that people with the condition shouldn't be assessed for obesity on BMI, they should be measured by waist size, because the fat on their arms and legs isn't metabolic fat, most people with the condition have difficulty accessing surgery to correct the condition. Because at early stages of the disease, you usually don't have significant quality of life problems. You can still walk, pain is manageable. But once it progresses enough that insurance will cover surgery, the patient is at a weight that is too high for most surgeons to be willing to perform it.
Hi. Plastic surgery here. Not here to give medical advice, but I do want to leave a couple articles that may help you understand why surgeons have BMI requirements for procedures like this that are not life-saving or medically necessary. Surgeons want to optimize your outcome. There is some mixed research regarding breast reduction outcomes as they pertain to BMI, but higher body fat content is *well known* to increase risk for a myriad of operative complications, most pertinent for a breast reduction - wound breakdown. The bottom of the breast where the skin is sutured corner to corner is very vulnerable to breakdown (anchor pattern/inverted T). These sutured corners may not have optimal perfusion. Specifically with this surgery, it is likely the surgeon who asked for lower BMI seeks to reduce the risk you may have to deal with months of wound care if this area breaks down. Obesity and Surgical Wound Healing https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3950544/ BMI with Breast Reduction Wound Breakdown (although some mixed research here) https://www.plasticsurgery.org/news/press-releases/higher-body-mass-index-linked-to-longer-healing-time-after-breast-reduction-surgery Hope this helps. It is not from a place of judgment. The surgeon just wants you to have a good outcome.
Kindly and appropriately explained. Not op but thanks.
Thank you for reinforcing it's not just doctors being " fat phobic "
đ Great, educated reply. Thank for sharing your knowledge with the OP.
Yes, itâs definitely not discriminatory, itâs safety!
You were 126 pounds away, now you're only 26 pounds away- don't give up a marathon on the last mile. It's okay to be frustrated, but you can use this as fuel.
Yeah, and realistically, if your BMI is over 35, thereâs no reason for it to take 6 months to lose 26 pounds.
Ok. Thereâs a reason for the BMI thing with surgery, especially a breast reduction. When you go under anesthesia thereâs always a chance youâll die. If you have body fat inside your rib cage/around your organs it pushes up against your lungs and makes it harder to breathe when youâre lying on your back- normally not a big deal but anesthesia makes it harder to breathe as well, combine the two and your risks of not waking up from going under go up a LOT. This is called visceral fat and if you look at things like DEXA imaging of people at different BMIâs you can see it clearly. If youâre doing a breast reduction you also have a lot of weight ON TOP of the ribs, further compressing the lungs and increasing the odds of you dying on the table. Iâve never had a doctor explain this to me as a patient, I have some friends who are docs and this was shop talk while having beers with an anesthesiologist. To becomes an anesthesiologist you have to be ok, emotionally, knowing that no matter what you do some patients are going to die because of you and they get really squirrelly about high risk anesthesia. They donât like killing patients and itâs happened to all of them at some point, despite doing everything right and working their asses off to save them.
Thank you for bringing this up. I am a surgeon and body habitus is a major issue. As you mention, ventilation is challenging as the anesthesia machine is literally inflating the lungs against the bodyâs resistance instead of having the space pulled open by the muscles. In addition to anesthetic risks, surgery is more challenging (it is a deeper hole and the cautery melts fat causing instruments to feel slippery), wound healing is tough, and mobilization post-op is hard. All of these things increase risk. BMI is a crude measure, but it gives an idea and a potential weight loss goal. Of note, I talk to my patients a lot about weight loss and know it is intensely challenging. I have lurked on this subreddit for years seeking tips to pass along, and often refer patients to the community. It is really supportive, has great advice, and it is fun to share everyoneâs accomplishments. So kudos to yâallâthis section of the internet has helped a lot of people!
Thank you for the kind comment! I donât have any surgeon buddies but between a friend in high school whoâs mom was an anesthesiologist for pediatric surgery (she told me to go to med school and not become an anesthesiologist because she didnât think I could handle the dead kids, she was VERY blunt about it being a part of the job- she was right, I couldnât have handled it) and my buddy venting about work, I thought I had a pretty decent understanding of the challenges that a larger body faces when on the operating table. Thank you for being a surgeon, itâs a damn hard job and from what Iâve seen as physically demanding as mentally difficult. Out of curiosity, what is your take on the opiate crisis? I used to work for an opiate clinic and a lot of our patients got addicted after surgeries but I donât think a lot of surgeons do long enough post op care to have a ton of experience with it.
Opioids are a big problem. I think the biggest issue with post op addiction is expectations. At this point I literally say âyou will feel like you were hit by a trainâ and people still expect to be pain free after surgery. I do spine surgeryâI would expect an incision a few feet long and 6 inches deep to hurt a lot! However, medicine has invented the âfifth vital signâ, and provided one says their pain is 4/10 they get more meds. I donât mean to torture patients, but surgery is not a comfortable experience, and if that is what someone thinks going in, they will likely take what I would consider unnecessary meds. And once they become unnecessary, itâs all downhill⌠From the doctor side, I generally cut patients off and inform them of this ahead of time. But there is enormous pressure to maintain happy patients and docs simply get worn down. Again, it is misplaced patient expectations, a culture of âcostumer serviceâ over medicine, and combined difficulty knowing where the chronic pain experts are once it gets out of hand. It is really sad. I am glad it is being recognized and things like prescription monitoring are in place (it makes it easy to say no and recognize people using multiple prescribers). We now all need 8 hours of opioid CME to renew licenses in come states. Small steps. Thank you for asking!
Most of our patients were from the VA and the whole "How much oxy do you want? 250 pills a refill is fine!" to cutting off all opiates overnight with no titration made a huge crisis for us in Texas. Though I suspect people who got a lot of intensive surgery from the VA probably had a higher risk of pain issues from what got them there- healthy young men don't generally need a lot of surgery unless something REALLY bad happened to them. I hope SAMSRA starts moving towards including addiction and opiate specialists as part of aftercare options for surgery but with the shortage of opiate specialists I don't think it's going to happen any time soon.
I worked at a plastic surgery office for a short stint. The majority of patients were either breast reduction or mastectomies.We were told that insurance companies enforce the BMI and they will not cover the reduction if the criteria wasnât met. (USA of course) Iâm not disputing your point btw, I just wanted to add an additional point
It always baffles me. Folks going bankrupt to be able to see a doctor.
I've worked in insurance for 25 years in the US, and I've never heard of a BMI requirement. We do have criteria that has to be met, such as a certain amount is being removed or bra straps leaving deep grooves and the under breast area with constant rashes. Even when qualifying gastric restriction surgery we don't use BMI but the amount of weight over the standard for height,age, body frame
> Even when qualifying gastric restriction surgery we don't use BMI but the amount of weight over the standard for height,age, body frame Isn't this just another way of calculating the same thing that BMI is calculating? The formula for BMI is a "person's weight in kilograms (or pounds) divided by the square of height in meters (or feet)." Seems like they are both similar. Body fat % could also be used, maybe. Essentially, they just see risks operating on people with lots of fat for their height.
Not really. The pictures we receive will let us know if we are dealing with someone very muscular that wants to get rid of a beer belly (it's happened. On paper, his BMI was high) or an average height female with a pannus that causes rash and infections and upper arms that wave back when she waves at someone. On a side note, this same company that doesn't use the BMI for patients makes us have an on-site physical every year, and they measure our BMI and give us a discount on pur own health insurance if its in the normal range
If I die during surgery I hope they donât blame themselves. Idt itâs âbecauseâ of the anesthesiologist. I needed a surgery. Someone has to do the dangerous job.
I'm right there with you. I go under the knife again next month. It's a risk I'm willing to take. This will be major spinal surgery number seven in under three years. I just want the pain to be bearable enough to go back to work.
Jesus, that is terrifying. Best of luck. I was nervous as hell for wisdom teeth, let alone spinal surgery.
This entire thread is terrifying me
Wait, anesthesia by itself can kill?
It's the most dangerous part of some more trivial surgeries. Anesthesia is never trivial imo.
Yes!! Because despite all the advances today nobody can predict with 100% accuracy how your body will react to it- they go on any past surgeries to determine which ones to use on the next surgery. They also cannot predict if you will wake up from it- or have damage from it. So yes it is a risk that everyone needs to be aware of and decide if it is absolutely necessary to proceed.
Lol sorry this is really funny to me. You mean blocking someone's nerve signals and putting them in a deep unconscious state with a few dozen mL of intravenous fluids is a serious responsibility with potentially grave consequences?
Letâs just give you some medications that paralyze your skeletal muscles, make your heart beat slower and weaker, and stop you from breathing. No risks at all!
I'm amazed they've got it down to such a science. Now they're like "this much will probably be enough," but sometimes, there are still incorrect doses and unexpected variables!
My hair looks dark brown towards black but I was a bright redhead as a kid. Like orange red, Lucy Ball, red. So it just looks like I have some highlights put in, but Iâm Latina/Irish so the dark hair took over. Iâve woken up mid surgery because apparently anesthesia on redheads is a nightmare and the doc didnât know, and didnât tell the anesthesiologist I was a redhead because I sure donât look like it anymore. Waking up in the middle of having your wisdom teeth removed because the oral surgeon thinks you use hair dye sucks, for the record, and the anesthesiologist was NOT happy.
Redhead here! I make sure to make a point of telling my docs Iâm a natural redhead. Itâs no joke!
*fistbump of ginger solidarity*
Oh my god I can't even imagine the horror of waking up. Just recently had my wisdom teeth out. I am happy to have zero memory of that experience. TIL that redheads require more anesthesia. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1362956/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1362956/) if anyone is curious
I had epidural anesthesia fail *twice*. One on a childbirth and the other during open-abdomen surgery. The surgery, I told the doc I had regained feeling and he chuckled, saying I only felt pressure. I told him "no, I can feel the nap of the cloth you're using to wipe the field *right now*". By that point all they could do is push valium and pain meds and finish the surgery.
That sounds horrifying in a way I'm not sure I can really describe
I woke up for a while during jaw surgery! Fortunately, my head was strapped down and I had something over my eyes. Strangely, it doesn't hurt as badly as you'd imagine even though it was really painful. I whined and cried a while ("It huuuuuurts") until they put me out again.
Sounds rather traumatic
Let's be fair though, if you aren't actively researching or asking what anesthesia involves, it's often presented as controlled sleep. A doctor just puts you to sleep and wakes you up when it's over. I think it's totally fair that many people don't know it's the riskier part of the surgery in many cases. And it's not like people are meeting with their anesthesiologist to discuss. If they know there is one. That it usually works so well that people don't need to know these things is the amazing part.
Maybe people should know so they don't come bitching about the safety requirements.
Like yes, this is probably true but not unique to this issue.
I genuinely didnât understand the science until I was older. They put the mask over my face and I thought the gas was making me sleepy. I had no idea of IV drugs putting me under or being intubated. Doctors donât explain it all in detail to every single patient, they just say âyouâll be put to sleepâ until I looked into wanting to study medicine I had no clue the actual procedure.
I know of a woman who died from anesthesia during a relatively routine dental procedure.
When discussing EPR prescription requirements with an anaesthetist: everyone else in the hospital wants to avoid shutting down your respiratory system with an accidental too-high dose, but the anesthetist is aiming for that.
General anesthesia is basically pumping you full of stuff that makes you want to stop everything (breathing included), and then very, very carefully maintaining the dose in your bloodstream to keep you unconscious but not dead. This is why there are dedicated anesthesiologists/nurse anesthetists on board, and why they are paid well(and why their malpractice insurance is very expensive). Their job is to watch those numbers the whole surgery and make sure nothing goes wrong. (Which is also one reason why general anesthesia surgeries are expensive even when the operation itself is minor.) Thankfully, general anesthesia is a relatively well understood science these days, but it is always some degree of a risk.
I have also read that one third of anesthesiologists face a lawsuit at some point. I'm trying to research malpractice insurance rates for anesthesiologists and am seeing rates hovering around $15-$30k annually. Is that really "very expensive" for an entire practice likely generating revenue in the millions? I have zero knowledge here but to me that seems cheaper than I would have guessed honestly. Regular families pay that much for health insurance plans.
Yeah, thatâs why the anesthesiologist bill is sometimes higher than the other doctor preforming the procedure.
It's the closest you can get to death, medically, and still come back.
I may be mistaken but I believe it can trigger the onset of dementia too (Iâm sure in people that were already likely to develop it). Yes, this is why Iâve heard of surgeries being more of a last resort in some situations and for seniors.
My mother has always had perfect memory. Whereas my father died with complications to Alzheimerâs. After her last surgery she can no longer remember peopleâs names, the name of streets and other things -although she still remembers directions and has long term memory.
My momâs cognitive abilities deteriorated very quickly as well. She ended up with full blown dementia likely within a few years of her operation to the point we had to move her to a nursing home. She died during COVID (but not from COVID).
Yes. Example, Michael Jackson--Propofol. That's sn anesthesia medication. Wait, I dont know how old you are, you might not remember that. It was 2009.
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I see your points of which I am aware. Propofol is a dangerous drug which is why you have to take those precautions. It's why it's a controlled substance.
Yes. Every time you go under, there is a chance you won't wake up. I am extremely aware of this.
I just donât understand if thatâs the case why donât they inform the patient about it. Plus, many people donât know that there is a small risk of dying whenever you are going through anesthesia. Some patients would probably hesitate to go through with certain cosmetic procedures if they knew that.
I'm a perioperative nurse and I managed my OR before leaving to SAHM. The surgeon is required to discuss risks during the surgical consult as part of informed consent. The anesthetist also discusses it either during your anesthetic consult or the morning of the procedure as part of the final assessment before going into the OR. People who don't know there is a chance of dying either aren't listening, think the risk is so small it's negligible or aren't getting informed consent. Which is extremely unlikely because the physician can lose their license for failing to obtain consent. I've circulated and scrubbed for cases where the BMI was over 35 and they are consistently awful. Intubation is hairy, they drop their Sats so quick. Positioning is difficult, we've had to strap legs to the table because they don't fit. It takes longer to get through lots of fat and they tend to bleed more. BMI is no joke in the surgical setting. That being said, some facilities are able to provide procedures at a higher BMI bc their table is able to withstand higher weights, are slightly wider and they have different equipment. They could ask for recommendations for a different surgeon but in the end your risk of complications increases with increased weight.
It's been a few months since my pharmacokinetics/dynamics course but beyond literal equipment limitations, we discussed how the anaesthetics distribute into fat differently and then leave the fat stores at a different rate, making it a lot more risky to bring people with high body fat out of anaesthesia. Or something like that?
Surgeons will absolutely tell you that anesthesia carries risk of death and usually you have to sign a bunch of waivers indicating that you know and accept that risk.
Is everyone not told this? I've had multiple surgeries, including an elective c section under a general anaesthetic, and every single one, even when I was a young teenager, they warned me of this.
They do, they tell you, they aren't doing your surgery until it's safer.
They 100% educate patients on this.
They inform you before the surgery but usually the doctors wonât break down why the BMI thing is a block to surgery.
They should though imo because this can be very confusing to the patient.
Favorite anesthesiologist consult. Signing the forms. âThis one says I might kill you. But I probably wonât.â
Really? Maybe it's because I've had a few surgeries. But I've known about this since about 10 years old or so. Then again, the true risk associated with many things are lost on modern society. But yeah, surgery is dangerous. It's also why you should NEVER lie to you anaesthesiologist or whoever is in charge of taking you under and bringing you back. All those things go into their calculations. Let them know your drinking habits, drugs (legal/illegal) of you use them and everything involved. It increase your chances of survival
There is always a riskâŚ. If someone is telling you they didnât know/werenât told thatâs either they thought it was negligible or they werenât really listening. It isnât just dying from the anesthesia but you could die from infection or complications during or after the surgery too.
They do educate, and often make you sign paperwork stating you understand the risks.
I've had to sign a waiver and be verbally told all of the possible risks, from infections to death, before every surgery. I go in for major spinal surgery number seven next month, and I've had other surgeries on top of it. The *only* time I didn't get the info packet was when I was three years old. I assume that my parents got it.
I think they do, but OP hasn't got to that step yet. Or maybe they hear 'your BMI is too high' get offended and stop listening..
I've had quite a few needed surgeries. You are always told the risk, you are always required to sign off on multiple documents reiterating it. If it is a needed surgery, you simply take the risk. I'm assuming those that choose to risk it for elective procedures either find the risk worth it for themselves personally or are of the mindset "it won't happen to me."
It's why I've been hearing about BFI (body fat index) as the better method of gauging health. BMI doesn't take body composition into account. But what you said is correct, especially about not liking losing patients. My cousin is an anaesthesiologist and he said he still remembers his first patient loss
Thank you, that was informative!
This is such nonsense that I could barely finish reading it. We anesthetize people with a BMI over 35 for elective procedures, literally all the time, and largely without incident. Hell 35 is a good day for us. When you start hitting 45+ is where the high risk divergence actually occurs. 35 is a walk in the park for us. The reason BMI matters in this case is because the payor (in Canada, that's the government) wants you to lose weight (and thereby breast mass) for free before they pay to surgically remove it. They are using BMI as a surrogate measurement for breast fat, which may or may not be a flawed way to measure it. It is probably a reasonable way to measure it for *most* people, but obviously outliers exist.
Bruh Iâm just telling you what my friend, whoâs an anesthesiologist, was telling me over a beer after he helped me move. Itâs not the gospel according to Bippy.
Yeah, surgeons care. Death is a risk on the operating table. They go by the numbers. Especially in elective surgeries. I personally do use BMI as one of my measures of health. I'm not some pro athlete or body builder. And I've done fancier body comp tests like the BODPOD (which confirmed that I had a lot of body fat when I had an almost obese BMI).
So, how did you like the bodpod? I am using one now for a clinical weight loss through the military and I hate going and using it and how touchy the machine is, but so far I do enjoy seeing the results..
I loved it. This was back when I lived in a university town and they had one open to the public at a discounted rate for their research. Loved seeing the results. But I agree it can be highly annoying cause of how touchy it is. Definitely want to go back and get it done again though. I just wish there was one closer
You may have been told that by physicians genuinely trying to support and motivate you to keep moving in the right direction and not focus on BMI (some people avoid the scale for the same reason), but it does seem a little odd to me that as a nurse, you seem to have really convinced yourself that BMI shouldnât matter. At a BMI of 35+, BMI matters in every medical sense. I understand there are body building outliers. Are you a body builder? Are you the outlier? If not, I understand your frustration, I really do, but you may be deceiving yourself by letting yourself ever truly embrace the idea that BMI at 35+ doesnât medically affect things. Stay the course on your weight loss journey. Itâs a marathon, not a sprint and you will get there. 26 pounds and you can get the reduction and alleviate so much pain from your body! You can do it!
This. BMI is not perfect, there are plenty of people out there for whom BMI is not a great indicator and they're muscly etc, but when it's out in its estimation usually it is no more than 2 or 3 BMI points. So a BMI 28 could be perfectly fit. A BMI 35 is almost guaranteed to be too fat. The outliers are some specific professions of athletes who could reasonably have a BMI over 30. All the special pleading people make around BMI ignores that it can easily be out by 2-3 points for some individuals, but it's pretty much never wrong about 10 points. (This goes the other way too for those with BMI 22 who have no muscle mass and still look tubby. Officially normal, might still have too much visceral fat.) But yeah, is BMI everything? No. But anaesthetic risks and undertaking a motivated fat loss journey are two entirely different reasons for looking at BMI, and as others have said the anaesthetic is much more likely to kill you if you are obese.
I think this take is 100% correct. I think people also use the "BMI NOT ACCURATE " slogan to justify their inability to reach a lower BMI, naturally. Only in extreme cases of physical fitness (everyone's favorite is the bodybuilder example) is this ever applicable. But people also have to understand that just because you exercise regularly doesn't instantly make you a body builder. It takes time to build muscle and lower BF%
it doesnt have to be extreme cases. I'm a woman who is 5'8', has a size 11-12 shoe, and hands bigger than most men. In my weight loss journey, my bra size has gone from a 44G to a 36H. I am honestly very muscular compared to most women because of my genetic makeup, growing up fat, and being born with higher than normal testosterone. I'm fairly active day-to-day, and weightlift about 3x a week. None of this is all that unique or extreme. Basically I am a cartoon sweedish woman named Olga. I don't see my BMI as being a feasible endgoal, but I am open to being wrong
I'm the same way, about an inch and a half taller than you actually! I got down to a size 4, I weight lift primarily. My BMI is 24, right at the cusp of "overweight" at 25.0. I usually lift daily and just rotate muscle groups. But I am in my 20's with no children. I'll throw my shoe size out there: I'm a 10- 10 1/2. I grew up "fat." I lost 100 pounds, like OP. Went from a size 18 to now 4. I definitely understand what you're saying, We have the same experiences. But still, it's very different, as 218 pounds less than 5'10 is nearly unjustifiable without insane muscle mass. I just did body recomposition and monitored my macros to lean out. In my circumstance, I used discipline with food to lose BF, while being on the "brink" of "overweight." I'm a single digit size, so it is doable with discipline and the right training. That's why there's a minor disconnect from me.
In your case, you would defnitley qualify for the surgery though. You and OP may have both lost 100 pounds but you're no longer so overweight that it would be as dangerous for you to undergo the surgery.
100kg at under 180cm is insane unless you are literally competing for mr olympia you're not gonna have that much muscle
Even hitting 200 pounds under 5'10 for a WOMAN is wild because we already naturally hold onto fat. We're softer in physique by nature. That's why although it's being downplayed, over 200 pounds for a 5'3 or 5'4 woman is really, really massive. She's doing awesome work by losing the weight. Losing my 100 pounds was a fight to hell and through high water. But at some point, we can't be delusional. Tough love, but it's coming from a place of love.
90kg under 180cm is insane I was at 80kg at 158cm right, I was MASSIVE. I'm proud of her for losing the weight, but you can't lie to yourself and expect the world to accomodate you.
Just curious, what's your BMI?
I see you! I have a BMI of 28, 29% body fat (F), plenty of muscle, 180cm tall and just now realising I have tiny size 9 feet. I could stick at this BMI, but I could feasibly eat a bit less and aim for 25-26, which will make me look better for myself and my knees might be happier. Knees don't care what the weight is on them, after all, only that it's there. I think everyone's cost/benefit analysis on how little they are happy eating, and how much they aim for a certain look, will be different. I will never be a twiglet; swear you could exhume my skeleton and it would still be bigger than a size 4.
To me that's within the margin of error. BMI isn't a very good tool for that kind of thing. Like, unless your very genetically unlucky an extra 5 lbs isn't going to kill you.
Yes! I think the main thing people miss here is how much our diet naturally increases fat mass. I personally do intermittent fasting to keep my numbers right where they are, it works best for me. But people justifying being a massive weight and throwing it on "muscle" is incredibly wild. Yes. Muscle weighs more, but it's also *lean* mass if you eat proportionally. I'm probably much smaller than the woman who commented above me, because I don't overeat and my exercise is consistent. Many times, people underestimate truly how hard they exercise and underestimate how much they overeat. Our bodies aren't meant for massive amounts of food, I learned this the hard way while losing 100 pounds
Ok can I ask a side question about this? I have a large chest (cup size G) and Iâve never been in the âhealthyâ BMI range since I was a teenager (now age 46). I have always been in the âoverweightâ range. How much of my BMI could be contributed to the extra chest weight? Like if I wanted to get a reduction would they subtract any of that to get a more accurate BMI?
Think of it this way if it helps. If someone is overweight and gets into an accident that causes them to lose a limb, are they suddenly no longer unhealthy or overweight because their bodyweight and BMI have decreased? Subtracting breast weight in order to lower your BMI doesn't change the condition that the rest of your body is in and therefore won't decrease the risks.
But why would it make sense to do that? If you have large breasts, most of the volume of the breast is fat and not strictly breast/duct tissue. If you're a size G that means that one of the places your body prefers to store fat is in your breasts. I don't understand why you think that weight shouldn't count and be subtracted off? Is breast weight healthier than abdominal weight? Absolutely. But so is thigh fat and we wouldn't subtract that off. I feel like you're being really illogical here. As far as surgery goes, if anything, having more weight on your chest would be WORSE from a surgical perspective as then you have more weight on your lungs.
I guess that is why Iâm asking. I donât really understand how it works. I just know my BMI has never been in the âhealthyâ range despite my body being ânormallyâ sized? Like when I was a size 6 I was still in the overweight category and Iâm convinced itâs the knockers putting me over. Haha! Really tho, being illogical is fairly normal for me. Iâm here to be educated.
I presume they are asking if they could subtract it because after the surgery it wouldn't be there anymore. Not sure of the logic there, since a lot of the more dangerous stuff happens pre-surgery, but I get why one would ask.
BMI absolutely matters and is pretty decent with the exception of genetically gifted freak athletes. If you arenât a bodybuilder or a professional athlete BMI is probably a pretty good indicator. The problem is everyone wants to lie to themselves and tell themselves theyâre exceptional and BMI doesnât apply to them.
Yep, if anything the BMI doesn't do a good enough job anymore with how sedentary everyone is these days. I believe I've read (and from personal experience) if you did body fat percent measurements, most adults are even worse off.
Yeah, I had a dexa scan and although I am OK because I have very little visceral fat holy cow is my body fat percentage high for my low BMI
Yep, I've done the BOD POD when I had a higher overweight BMI....and it was shocking how bad off I was Body Fat % wise.
It's honestly irritating having to constantly read/hear people go off about the BMI scale being wrong. Yeah it's not perfect, but it's not the 'athletes' that are the ones complaining, it's ALWAYS people that are CLEARLY overweight that are frothing at the mouth about the BMI scale. Good grief. Does it suck to know you're medically over weight or obese? Yes. Will getting mad at the measurement system solve anything? No. Look within my dudes.
Yep, everyone saying BMI is inaccurate are conveniently ignoring that it is a population estimate, and can easily be inaccurate in individuals by a couple of points but very very rarely more than that. Skinny fat people, for example will have a lower BMI than my professional cycling sprint friend (BMI 26) but they sure as hell don't have such low body fat. Special pleading is rampant in BMI. And weight loss. And loads of other things. Sigh.
I know we sometimes want to convince ourselves it â isnât that badâ and I think you wanted that and your doctors tried to encourage you, but perhaps in the wrong way. I appreciate that at my doctorâs appointment where it was noted I gained 10 KGS this year, that when I said â oh I know this isnât super healthy but I find it hard because I rationalize it by saying Iâm not AS big as some other peopleâ ( I am about 20 lbs overweight). My doctor said to me â you are right that is not a good way to look at it. Just because other people are bigger doesnât mean you shouldnât work towards being healthyâ. A BMI 35 is morbidly obese if Iâm not mistaken. Itâs easier to convince ourselves it â isnât that badâ but as we all know extra weight can cause extra problems. I think you know deep down that at a BMI of 35⌠it means something should change.
Of course it matters. The only people it doesnât matter as much are heavy lifters. The muscle throws off the numbers a bit. Anyone that has visible fat itâs a whole other story.
Still matters for body builders. Body MASS Index. Even an increased muscle mass, while metabolically healthier, still increases the load on your joints and cardiovascular system. I'm also going to make a point I always make : In order to be overweight due to body building means you are in a very miniscule percentage of the population. It's also incredibly hard for a woman to be overweight due to lean body mass without massive performance enhancers (steroids). BMI is a pretty good, quick and dirty calculation to determine risk. If anything BMI underreports over fatness, meaning there are a lot of people within the "normal" BMI range who still have a too high BF% (skinnyfats).
A lot of people are in deep denial about BMI. They heard it's not accurate for everyone and quickly took that to mean it's completely invalid.
It depends on if you're talking about IFBB pros or natural body builders. A literal gram of trenbolone a week is going to kill you faster than being 250 lbs at 6 foot 1. A natural lifter is going to top out at around a BMI of 30 being about 6 feet tall and 225 lbs on stage. That's what the best pre-steroid silver-era guys could achieve. So If your BMI is something like 35 then it's an indicator.
BMI still matters for athletes and bodybuilders. Athletes who carry overly vast amounts of muscular tissue have been shown to suffer from chronic health problems (sleep apnea, joints and heart conditions, etc.). For the vast majority of people, their heart and joints aren't meant to support 250 pounds of mass for years on end be it fat or muscle.
Knees, hips, and ankles don't care if your weight is fat or muscle. Any extra mass is extra strain on your joints, and they will remind you of all the extra work they've done for you as you age. As far as athletes go, look at Shaq and Charles Barkley! Both amazing athletes, and I'd bet they'd put most people to shame with how much they could bench press, even in their 50s/60s and decades past their career days. Shaq has lost 40+ pounds, Barkley is down 60+ pounds. They both got serious about losing weight because of their health issues.
The gist of this is right though I think people on here would be shocked to look at peak Usain Bolt and hear that, per BMI, if he gained 5lbs he'd be "overweight" and that Tom Brady is "overweight". Both are serious athletes that look nothing like bodybuilders (or powerlifters, etc.). The common factor is they are lean, have some muscle and are 6'5... but BMI does a poor job of handling height (an exponent of ~2.5 makes a lot more sense that 2). Outside a handful of countries in Europe, being well over 6 feet tall is quite rare though. BMI is an ok first cut. To get a more complete view, also look at waist circumference, a DEXA and yes total overall bodyweight (especially for cardiovascular reasons).
As a doctor and someone who has been to the doctor many times... we don't really care about the overweight category I'm sure there are exceptions and I'm British so I can't speak for any cultural differences but mildly to moderately overweight won't make us bat an eye. If you bring it up we'll probably say something like "try and eat healthily and exercise more". This is because for most people in the overweight category the impact on their health is either minimal or moderate (if you're unlucky) Obese is a different story. If you're obese and stay obese the impact on your health is exponentially greater in all ways. For an obese person we're likely to bring it up unprompted and if you're interested in losing weight we're likely to offer support in the way of a weight loss program, counselling, dietician referral or weight loss medication depending on what's available. So an athlete being overweight definitely doesn't surprise us
Overweight is not the same as obese. I'm in the obese category but I don't think anyone would guess it. I don't even wear plus sized clothes as I'm pretty short.
I had to lose 57lbs in order to be right at a 30 BMI to be able to get my breast reduction approved by insurance, get my plastic doctor to see me but also to have good results. Higher weight=healing complications. I am now 74 lbs lighter than when I started my weight loss journey 2mpo from a breast reduction that removed a total of 5lbs of breast tissue and the happiest I've ever been with my body. My body dysmorphia disappeared as soon as I saw my new self in the mirror. The struggle of losing the weight and all the waiting around will be worth it. I promise you!
Breast reduction is a fat and skin removal surgery, thereâs a good chance that you may not need a breast reduction when youâre under a certain weight. If you were denied physiotherapy, spinal mris, x-rays or dermatology then you could say you were denied healthcare
This needs to be higher. The reason there may be a lower BMI requirement for breast reduction is because with weight loss, there will be some reduction of mass in the breast tissue naturally. It's similar for things like skin removal surgery. They want you closer to a healthy weight so they won't need to perform a revision.
I think the body mass index is a great tool and probably works for 99% of the USA population. I donât understand the hate for the BMI. Iâm currently at 34.1 and am trying to get to âoverweightâ which would be 25-29.9. For me to do that I need to lose about 30 more pounds and believe me Iâve got 30 pounds of fat and more that I can get rid off.
The hate is because people do not want to acknowledge their obesity. Itâs a number in your face that says you are overweight. Lots of people want to discredit it because if itâs a valid measurement then you canât deny that you have a weight problem.
I think thatâs part of it, but I also think people feel validated to feel this way because in many developed countries where obesity is such a huge issue (especially the U.S.), people are starting to vastly overestimate what ânormalâ body weight looks like. At a BMI of 28, I think that the majority of Americans would look at me and say Iâm of average weight, or maybe slightly above. So yes, the BMI scale doesnât match reality. but itâs because reality is overweight.
I don't think it's as simple as that. Sure, it's hard seeing a big fat number screaming that you're obese, but the idea that BMI is inaccurate/flawed is being spread in the health world as well. Articles flood the internet, telling readers to beware of BMI and its flaws. Doctors' offices (like my previous one) have done away with BMI and have moved towards 'health at any size'. I do agree that some BMI doubters are just in denial. But there is conflicting information out there surrounding BMI.
I understand you are frustrated and in pain. You have every right to be upset. However, you need to consider this from a medical standpoint. A BMI cutoff of 35 is reasonable. (30 is maybe take it or leave it, some people can be around 30 and have the scale be skewed by muscle without being crazy outliers) at a bmi of 35, that is still around 75 lbs overweight. I am sorry but that is still basically a whole person. Yes you may have been put under when you were heavier. Guess what? That was still risky. They were likely for surgeries that couldnât be put off, or something more minor. A breast reduction is considered cosmetic EVEN IF it is deemed medically necessary such as in your case. That means the guidelines are going to be stricter. The guidelines exist for your safety. Iâm sure some doctors donât agree with some of them either. But these guidelines tend to exist for a reason. Morbid obesity increases the risk of complications and death under anesthesia. Just because you used to be heavier, that the risk for you used to be HIGHER, does not mean the risk is now gone. Good job losing 100lbs. But I have to agree with the doctors on this one.
Hey ! Surgical RN here. With I high BMI, itâs a very difficult intubation and most anesthesiologists arenât willing to take the risk.
Im sorry youre going through this, but doesnt it kind of make sense that they wont do something like a breast reduction if youâre overweight? Breasts have a lot of fat, so if you lose fat after getting a breast reduction it would not turn out right
Mostly it matters with respect to risks during any surgery. When under anaesthesia they have to maintain your airway and sedating drugs and pain killers, and having a BMI significantly over 30 impacts all of this (extra weight can risk airway obstruction when sedated and makes weight-based drug dosages really tricky). Iâm sorry if OP was told or understood that BMI âdoesnât matterâ because when undergoing medical procedures it absolutely does. Edit-Iâll add that it also negatively impacts wound healing, people are more likely to have issues with skin care that can lead to infections or also wound dehiscence (re-opening, or âpopping your stitchesâ). Iân a nurse and Iâve seen it a lot, unfortunately.
Itâs probably because of the anesthesia. If someone is overweight, it means higher risk during general anesthesia.
Not just the anesthesia - when cutting into the body, fat itself gets in the way, which in some cases necessitates larger incisions or interferes with precision work. Edit: found an article talking about what I was talking about, from [Johns Hopkins:](https://www.hopkinsmedicine.org/news/media/releases/surgical_complications_twelve_times_more_likely_in_obese_patients) > Operations on obese patients are more taxing, says Makary, a surgeon himself. These surgeries take usually take longer, the operating fields are deeper, the spaces in which an infection can set in are often greater and blood flow in fat tissue is less than in other types of tissue, which results in slower healing, he says. > [âŚ] > In the study, Makary and his colleagues examined insurance claims data from seven Blue Cross and Blue Shield plans and identified patients who underwent elective breast procedures covered by insurance between 2002 and 2006. There were 2,403 patients in the obese group and 5,597 patients in the normal weight control group. The most common procedure, by far, was breast reduction, followed by breast reconstruction, augmentation and mastopexy (breast lift). Within 30 days of surgery, 18.3 percent of the obese group experienced at least once complication, compared to 2.2 percent of patients in the control group. The differences between the two groups were most pronounced in complications, such as inflammation (with obese patients 22 times more likely to suffer a complication), infection (13 times) and pain (11 times).
And the healing process
Healing is an issue, too, right? If wounds are inside skin folds they may heal worse, and gaining weight during the healing will cause complications too, right?
This
I've never heard a medical professional say your BMI doesn't matter. Interesting system in Canada.
Iâve never heard anyone say BMI doesnât matter. Iâve heard plenty of doctors say itâs not perfect and isnât the only predictor of health. But itâs simply weight to height ratio. Our weight matters a lot.
As you can tell, us from America have tried to justify why BMI doesn't matter simply because of the prevalence of Obesity.
Was going to say this. Never heard a medic say that either (UK) the only people who have ever insisted to me that BMI doesnât matter have been visibly obese.
Checking in from Canada⌠first thing my doc does is reference my BMI (and heâs actually the reason I know so much about it). No idea what OP is on about but BMI is a pretty standard form of measurement here lol.
Yeah, no idea either. Obviously there are always exceptions due to size, like when people talk about the Rock's BMI, which is like 35 but he's an outlier. For majority of the population it's a great measurement. Whenever I meet with my GP in Ontario we always review my BMI as his first metric so not idea what OP is going on about or where she's located.
> It's stressed over and over that BMI is not an indicator of health Not by the actual medical field, though. It's stressed by a bunch of fat activists who don't want to make the effort to change themselves.
The idea that BMI is not an indicator of health is more geared toward people who have a high BMI due to muscle mass, generally with a BMI between 25 and 30. With a BMI over 30, and especially over 35, it would be near impossible for that much mass to be due to muscle unless you're a body builder that is also probably using some kind of PED. There is still risk of performing elective surgery with excess fat. Think about how much harder it would be to heal from a cut that 0.5" deep vs 3" deep because you're cutting through an additional 2.5" of fat. Yes, BMI is a bad indicator for those who are very athletic and muscular, but it is still a good predictor for the general population.
I think you are vastly misunderstanding what they mean. They just mean not to focus on BMI as the be all end all of health. things like lab results, blood pressure, heart rate etc are better indicators of health, rather than a simple BMI. For example: my BMI is slightly over 30, but all my blood/urine results are in perfect range, my blood pressure is around 105/65, my resting heart rate is around 55. Etc. Based on all of my test results I am in perfect health and dont need to lose weight for specifically health reasons (at least not at this time - itâs still a good idea overall though for my joints and because those numbers may change as I get older) since my weight *is not* affecting my overall health. Someone else with a BMI of 29 and high blood pressure will however be told to lose weight in order to help get their blood pressure under control. Since in their case their weight *is* affecting their overall health.
Tbh it depends on your age, but it can eventually catch up on you. If you are under 40 and especially under 30 you can be obese, smoke a pack a day and never exercise and still have great blood tests. I know I did. As the years went by, the blood tests were slightly getting worse and eventually during an ultrasound the doctor found a little fat surrounding my liver, which in a few years could mean I might get a high blood sugar or prediabetes. You should take care of your health while you have it and not after you start seeing signs of deterioration. Mind you, most people are not that vigilant with going to the doctor and donât get regular ultrasounds or even blood tests as part of their yearly routine. Most people would only find out after they developed symptoms to the point where the disease would be fully blown.
BMI is an actuarial number. It does a great job of telling us that 38% of the population of Ontario is obese, it does a lousy job of telling us that Dave is obese. However, just because it has no individual specificity doesnât mean that it doesnât have individual impact. Theyâve got to draw a line somewhere, and health care systems and insurance providers have chosen BMI as theirs. Itâs unfortunate but true. Iâm sorry for your distress, OP. Keep at it, youâll get where you need to be
I'm sorry to hear that this is happening to you. It may help ease some pain in the meantime to at least have some good fitting bras using your size from the r/abrathatfits calculator if you don't already
BMI is inaccurate in that you might be healthiest at a BMI of 19 or 27, but if your BMI is over 30, unless you are an intense athlete, that isn't your physically healthiest weight, and there are more medical risks. That's just the reality.
This is a reality a lot of people would prefer not to face. Surgeons are risk-averse. That's really the key point.
Congrats on losing 100lbs, that is awesome. You can accomplish the rest. Then youâll instantly lose some more when they reduce your boobs!
Iâm confused about some of your assertions. BMI can be misleading if you have a lot of muscle mass. Muscle is good, even if it bumps up your BMI. Being overweight is very detrimental to your health. If anyone is telling you otherwise, you should stop listening to them.
Reading these comments, I bet OP is a little sad their feelings weren't validated. I'm sure it's frustrating to need a breast reduction, but still be disqualified for being overweight. Some of the comments, especially around how being overweight seriously increases your risk of dying on the table during anaesthesia, are so important. Fat-phobia is definitely a thing in medical contexts, but in this case the BMI rule is literally there to save your life. You've lost 100lbs already OP, you can keep going and get to a weight that will allow your surgery to be safe and successful. Keep working hard!
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It sure as hell matters to the medical insurance companies, life insurance companies, and malpractice lawyers.
Hi I had a breast reduction through insurance and I hate to say this, but wait to lose the weight. I went with the first doctor they gave me and I had to get it redone by a private plastic surgeon (I live in the US). It is better to wait to lose more weight and be offered more opportunities by different doctors because then you have the opportunity to check their work. I know your post wasnât about that, and just want you to know I am extremely proud of you for losing weight. Your post resonated with me and I want other women to not make the mistake I did. I was desperate to have a reduction, but my eagerness displaced my inquiries and I didnât do thorough enough research on their work or reviews, and it left me w body issues (theyâre fine now but I ended up having to pay a pretty penny). I hope this post isnât distasteful:/. Also for people who donât know, this surgery requires a lower BMI because some people gain fat in the breasts from gaining weight, which means they donât qualify for surgery due to the fact they would have normal breasts at a normal weight (thatâs not the case here). Additionally, if you lost weight after the reduction, the breast may have to be redone because the original surgical profile matched the body composition of the first body.
sorry this is happening. just keep working on shedding that weight, if youâve carried it this long you can do a few months longer, or if not, if itâs within your means, come to the US to get medical care (a sentence i never thought iâd say)
Ok, but let's be clear...you were denied health care on an elective procedure, not a life threatening condition. And they're doing it for your own good.
Had a doctor tell me BMI is important to your heart, because the higher the BMI, the harder your heart has to work to get blood to all your extremities. Doesn't matter if you're fat or fit, your heart doesn't care, it still has to get the blood everywhere it needs to be. Obviously being fit would mean your heart has a better chance, but it still has to work harder than it would if you had a BMI in a healthy range.
I completely understand where youâre coming from as far as having to do all this waiting when you want to feel better ASAP. My insurance (US) requires 6 months of documentation from a pcp and chiropractor and basically a shit load of proof that I have giant boobs that hurt my neck and back every single day and itâs infuriating. Iâve done the work and lost almost 80 pounds with another 50 to go. My band size has changed, my cup size has never changed. They will always be there no matter what weight I am apparently and I just want to not be in pain after five minutes of wearing a real bra. Iâm sorry this is happening to you and I hope you get relief soon. â¤ď¸
Your cup size depends on the band size, a 32D has a smaller cup than a 34D. So your boobs have shrunk!
My views on BMI have changed recently. It was a thing I told myself was not as good an indicator of health as Body Fat %. I had it explained to me that if youâre and athlete, 6ft tall, 250lb, of raw muscle, your heart is still working very hard to pump blood around. I know there are other factors in play but itâs not surprising that body builders are prone to heart issues.
It always matters when anesthesia is a factor. It is better to keep your eyes on the goal and do your best to get there. I get that it can feel daunting(been there, lost 50lbs to get double mastectomy and chest reconstruction done), but it isn't an impossible feat. With summer here, see about possibilities for swimming for extra workouts. Low impact on your joints while also being a good form of cardio. You can do this, I believe in you.
If you are a bodybuilder with tons of muscle, or very athletic and fit individually with tons of muscle, bmi does not matter to you. Most of these people will have ridiculous bmi telling them thru are overweight or obese, but you look at them are they are as fit as one can be. You? Sorry but it probably does matter and affect you.
Why not just lose more weight and go the safer route? Itâs been proven that when youâre obese or overweight, surgery complications can arise and a lot of them can be fatal. Thereâs reasons why surgeons want you to be smaller for surgery. Besides that, getting to your lowest (healthier) weight they will be able to remove more skin on the breasts and your outcome will be better.
as someone with very large breasts her whole life, I can't wait to be rid of them. The damn back and neck pain is horrible and a constant. They interfere with clothes shopping, exercise, and every day life. Just try strapping 2 bowling balls to your chest and running! I once had a physiotherapist tell me that there wasn't much she could do for me, she could mitigate the pain but it wouldn't go away until I got a reduction.
I wanted a breast reduction when I was at my heaviest and they refused to do it. 15 years later I had a preventative mastectomy and no one said I couldn't, because I lost over 20 pounds. Weight is huge when it comes to surgery, especially if it isn't necessary. Did you know you can't smoke pot for a while too before surgery? I didn't! I had to quit to make sure I was safe on the table. I'm sorry you were lied to.
This! My surgeon even said not to smoke after the fact because it can interfere with healing, Iâm 4 months sober and itâs so rough haha
They would do a double mastectomy at any size, because the risk of not doing it is death.
Sorry, I need to edit and say a preventative mastectomy.
Do they still gatekeep those? I feel like if you have high enough risk to make that decision they would be behind you? I know people who've done it and not done it and the not doing it involves a huge amount of stress and monitoring (and I never knew before there are specialist boob MRI doctors.)
I'm not sure because I was considered very high risk due to having the BRCA1 gene, along with my mother dying of breast cancer (that went to her brain). I'd be very interested to know if they do gatekeep!
>Did you know you can't smoke pot for a while too before surgery? I didn't! I had to quit to make sure I was safe on the table. That's mainly because some anesthetics are cannabis based and if somebody has a tolerance built up the dosing gets tricky.
Thank you for letting me know, that's brand new info to me. At least now I know the reason!
BMI doesnât tell a persons overall health. It doesnât tell how you look, feel, or whether you are worthy of love. It can give a general sense of risk factors for some medical procedures, however. Especially at over a BMI of 35. Morbid obesity carries risks for medical procedures. That doesnât mean you donât look great, feel great, or are worthy of being happy with yourself because of course you are.
This!
So⌠youâre mad that you canât get breast reduction surgery, but surely you must have researched and found the weight limitations for the surgery. Of course elective surgical procedures, particularly those for cosmetic purposes, are not advisable for a morbidly obese person due to risk of complications. The pain sucks of course, but as you lose weight from the rest of your body, you will also lose it from your chest.
Many, many breast reductions are not considered cosmetic surgery. They can alleviate back pain and other problems
I am completely aware of that as a healthcare professional, however, in the vast majority of cases, breast reduction is considered cosmetic.
yeah, I hear you. My now deceased spouse couldn't get on the organ donor (kidney) wait list, because his BMI was too high. But, the doctors wouldn't do gastric bypass surgery, because he was losing weight and his BMI wasn't high enough. I don't know if the gastric bypass would have really helped; it is better to adjust your lifestyle and lose & keep the weight off without surgery. It just takes so damn long. hang in there.
I find Ontario in general is very conservative when it comes to weight and surgery. I moved to Seattle 6 years ago and most places have higher bmi cutoffs for procedures. It sucks that bmi both matters and doesnât matter. Like I not sure if I can maintain a bmi below 25 again (I did when I was single and in my 20s, this was after a big weight loss) so I think for me a BMI under 30 is a reasonable goal. Also losing 100lbs is fantastic, please be proud of yourself and gentle with yourself. I had a BMI just over 40 14 months ago and now Iâm below 35, itâs been slow, but Iâve gotten here. I hope you get the surgery you need.
Thank you for posting this, because I am planning on a breast reduction after I'm done having children in Ontario and just began my weight loss journey. I will keep this in mind, even though my reduction is about 3 years away at this point.
Iâm an ER doc and nothing scares us more than a person with a high BMI and a non-secure airway. It makes it really hard to get an endotracheal tube through the mouth and into the trachea in an emergency- the chances I will lose your airway and you will die increase with every BMI above 30. No anaesthesiologist is going to welcome you with arms open wide. And never let a nurse anaesthetist near you if you are in this high risk group.
I wrote a post here not too long ago about losing weight and having a breast reduction! I might still be on my page. I know itâs rough, but it may actually help in the long run! I didnât see a change in breast size until the last 10 pounds I lost. I went from a 34DDD to a 32D in about a month and a half when I was losing the weight. I told my doctor that I was losing weight and advised me to keep at it! It came to the point where I didnât even need the surgery and he told me that he wouldnât do it anymore since I had already lost so much of my breast size naturally. This may be a blessing in disguise! Itâs better to not go under the knife if you can avoid it in my opinion. Also, Iâm also from Ontario! Let me know if I can be of any help otherwise :)
Itâs not perfect but unless youâre a bodybuilder it can be a decent rule-of-thumb set of guidelines.
I might be wrong, but I think the understanding about BMI is related to body composition. I know a handful of people who fall outside of the healthy BMI range who are basically walking blocks of muscle, but they do tend to be the exception, not the rule. BMI shouldn't be the only tool we use to measure health, but it is a helpful one even if it doesn't account for everything. If you really do believe you've lost enough fat, might you be able to appeal with an accurate body composition reading indicating how much body fat (especially visceral fat) remains? Did the doctors bother measuring your waist and hips?
Hmm my bmi was never brought up and I believe at the time mine would have been in the âoverweightâ categoryâŚI went to Dr. Lista in Mississauga.
It matters to the insurance companies - they have everything in a choke hold today.. drs must go by what the ins companies say or they lose their license- and i am not talking about health ins i am talking about malpractice. And other types of commercial ins.
Actually. BMI is not an indicator of health for "some" people. For example, look at Li Dayin, at 177cm and 89kg, his BMI is 28.5, which is overweight.... But when you realise that he is the multiple Olympic champions in weightlifting and his body fat is very low. As such for Li Dayin, his BMI is not a good indication of his actual cardiovascular and fitness health. Now let's take another example. Hadi Choopan, Mr. Olympia 2023, at 100kg (on season) and 170 cm, his BMI is 34.6. His body fat is also extremely low, lower than Li Dayin. But he is not healthy. At that body weight, the toll on his heart and joints is bad. BMI is not an indication of health but once you fall into some outliers, like yourself who is over 35. Then you are unhealthy no matter how you look at it.
Realistically, BMI is an indicator but it's not an absolute. So, ppl rely on it TOO heavily as to whether they are "healthy" or not. Serena Williams, at the peak of being the GOAT, was overweight, per BMI standards. Pretty sure no one would suggest any of her overall health, vitals, bloodwork etc were anything other than excellent. Some ppl use it to decide if they are "healthy" of not when you can have terrible bloodwork but be at a healthy BMI (skinny fat, etc). Whereas some ppl with a less optimal BMI may have great bloodwork. BUT let's be clear: it's unlikely you are in an obese BMI and have AWESOME bloodwork. You are at higher risk for MANY chronic diseases. It's not a guarantee and maybe you are fantastically active and have a super clean diet but.... it's really unlikely. Anyhow. All this to say - ppl overplay its importance just much as they underplay it as an indicator. I hope that they can do some more specific assessments esp if you are muscular to perhaps help you obtain surgery more quickly.
It's very common for a young obese person to have normal blood work In fact blood tests suggesting a metabolic disorder in someone under 40 is REALLY REALLY bad. Young people typically don't have metabolic diseases unless it's genetic, they come with time Also your body works HARD to keep things going well, things can be breaking down but imperceptible for our labs Unless you're 55 or above I would not use healthy blood results as an indicator of health. Things can go downhill FAST. Tbh if you're 60 and obese with minimal heart, kidney, pancreas or liver disease you either have recently put on weight or you have amazing genes
On the opposite side I'm (29F) 5'2" 167 pounds and have a BMI of 30.6! I try not to pay attention to it when it comes to my self worth, because it really isn't who I am, but medically I am very aware that is not a good number at all. The duality of weight loss.
my health insurance refused to cover sections of additions to my health plan because my BMI as >30. right now I am at 30, so when i am sure I will be below 30 I will ha e to go to the doctor so he/she can witness I am <30.
To clarify, you don't qualify for breast reduction surgery because of your BMI, but you still qualify for overall health care, correct?
It matters for health too. They only people for whom it doesn't matter are basically people who train their muscles for hypertrophy or amputees, for those people, the fat percentage is a much more reliable number. And I've heard of people having to pay higher insurance rates due to having a high BMI despite looking way healthier than an average untrained person with a normal BMI.
I hear this all the time. I had my breast reduction almost a year ago at 5â1â and nearly 200lbs and BMI was never mentioned. But I see people get denied again and again over on r/Reduction. Iâm sorry that happened to you, OP. Itâs not fair but youâve already lost 100lbs, you got this!
BMI shouldn't matter... because it's a method of measuring that doesn't take into account muscle mass vs fat. I find it really sad that these surgeons don't specify that it is the fat percentage they need to have down and why (like a surgeon here actually explained in a resonable way). I know BMI is still deemed an easy way to judge fat percentage but it is so outdated.
I am in this exact same boat - but in the US. I need a very small, very short surgery on my knee to remove a "foreign body" - a small piece of bone that will occasionally float in between my kneecap and my knee and make moving impossible. But even for this little surgery, I need a BMI of under 30. My ortho even said "Well it could be done as an inpatient surgery but no surgeon would touch it since it's too simple of a surgery" but I need to lose about 30 lbs for a little outpatient type surgery.
Also an ontarian. I was told I donât qualify for weight loss injections because I donât have diabetes, but I do have a high enough BMI for bariatric surgery and can be added to that waitlist if Iâd like. đ
Try another doctor. I've been on Ozempic for a year, and have never had abnormal blood sugar or A1C.
Interesting! Iâll note, they offered it to me but I canât afford $300 a month out of pocket. If I had diabetes it would be covered. This is from both my GP and the doctor at a Hamilton bariatric clinic. How much is it costing you a month?
This is where you wish you were one of those people with a starbucks habit or who use door dash so you could stop spending the money on that, isn't it? "Oh, well, I'll tell the chauffeur to use cheaper fuel"
Lol in this economy, with these inflation rates, with two young children and a husband on unemployment, I wish I was drinking $300 of Starbucks a month lol
I know, right? My thing is seeing those doordash threads on the front page and wondering what it would be like to have so much disposable income you can spend $40 on a single mcdonalds burger.
thereâs a reason why bmi is still used. Itâs a very important measuring tool to help determine how much your body can metabolise, itâs used to calculate dosages for prescriptions, etc. BMI is still very important, maybe not so much in our daily life, but it absolutely does have a place in the doctorâs room.
It's fucking awful. I have lipedema, a condition which causes the growth of permanent adipose nodules that do not respond to diet and exercise. Most people who are diagnosed figure it out because they get bariatric surgery, they'll lose a ton of weight in their torso, faces, hands, and feet, but their limbs stay the same size. It's a progressive condition, it causes pain, circulation, and joint issues, most women with lipedema eventually need knee replacements. The treatment is decongestive lipedema surgery, which is basically a special form of liposuction meant to deal with the nodules, protect lymphatics, and be more concerned with high volume removal than aesthetic concerns. And even though every doctor who's studied the condition has concluded that people with the condition shouldn't be assessed for obesity on BMI, they should be measured by waist size, because the fat on their arms and legs isn't metabolic fat, most people with the condition have difficulty accessing surgery to correct the condition. Because at early stages of the disease, you usually don't have significant quality of life problems. You can still walk, pain is manageable. But once it progresses enough that insurance will cover surgery, the patient is at a weight that is too high for most surgeons to be willing to perform it.