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January 05, 2013


James Leo

Nice post for readers thanks for sharing it all.


Reading your blog has been such an inspiration (I hate the triteness of saying that, but I really do mean it!) to me over the last few years, whether I've been feeling bad about my own weight loss struggles or any other uphill battle in my life. I am constantly amazed at your work ethic and your determined attitude, but also your willingness to share your discouraging times and your disappointments with us. It sounds like you have many people in your life - both IRL and on this blog - to give you love and support during this frustrating process, but let me add my voice too! I'll be working out a lot in the next few weeks and I'll be cheered by the thought of you doing the same thing.


I have the highest possible admiration for the work nurses do. At the same time, I agree with you that reason #2 given to you doesn't really have anything to do with BMI.

My guess is that the staff on the front lines in these situations are, unfortunately, often left to answer questions like yours without much direct preparation to do so, and the reasons you were given were the best a well meaning person could come up with.


Thanks, Susan and Theresa, and MSF, thank you for the very informative explanation about BMI's use in medical decisions.

Now, the nurses who were talking to me about my surgery were SUPER nice and sensitive. Really, they couldn't have handled the situation any better than they did, and I am grateful. But the two specific reasons they gave for why their surgery center has a BMI limit were that 1) the patient was at a higher risk for respiratory problems like sleep apnea which they were not equipped to handle as a hospital is; and 2) heavier patients present a higher risk of injury to their own medical personnel, and a hospital has more resources to deal with that.

I fully understand reason 1, but I wonder if you can address reason 2. There are, for example, muscular, tall guys who weigh the same or more than I do but have lower BMIs. How am I more dangerous for the medical personnel? That's the part I don't understand.


I'd like to take a stab at addressing the question you posed above about how BMI is used in medical decisions. I have a ph.d in public health and my research is in the area of obesity prevention, mostly physical activity and health.

BMI has been used for over 100 years, but in the 1970s, research showed it to be a really good proxy for body fat percentage. Since then, we have learned that BMI and body fat percentage can predict a wide range of health problems. This type of research is primarily aimed at figuring out, on average, what the relationships between BMI and health risks are. Another way to think about this is to say that when faced with two people who are identical in every other way, the one with the lower BMI will likely have lower underlying health risks than one with a higher BMI.

In any research or health care context, there are things we know about a person beecause we have actually measured them, and things we don't know because we either can't measure them or meausuring them would be cost prohibitive. I'm guessing that this surgery center has decided that it is cost effective to use this one virtually no-cost indicator to substitute for the huge battery of costly labs and stress tests they would otherwise need to determine a person's underlying risk, and there's a raft of research evidence to support the cost effectiveness of that decision.

If they measured everything they could about your health status prior to the surgery, they could probably determine that you are a fabulously healthy person who happens to be heavier than is ideal. But to determine that to the satisfaction of their accrediting organization and the company that underwrites their malpractice insurance would be so expensive and time consuming that it wouldn't be worthwhile to them. Also, it probably wouldn't be worthwhile to you, as your total procedure costs would start to be a lot closer to those quoted for you to have the procedure at the hospital.

The hospital can "afford" to do the procedure perhaps without these pre-op tests because they are better staffed and equipped to handle unforeseen problems should they arise.

So, I know this all is intensely personal for you, and I'd be as upset as you if I were in the same boat. At the same time, I would just offer that the very medical model that allows us to have something like the lower cost outpatient surgery center is predicated on using things like BMI as short cuts to determine who can be cost effectively treated in a lower intensity setting. If we reject the use of indicators like BMI in medical decisions, we are essentially rejecting the model of care that allows us to have the option of outpatient surgery, which would cause our nation's health care costs to be even higher than the astronomical levels at which they are already.

I hope this helps.....I'm trying to blend my personal reaction to this with my professional lens.

Theresa K.

You remain a strong, beautiful and inspirational woman to me. Your honesty in your most recent challenge makes you all the more inspirational. You may very well fight this battle every day for the rest of your life , but it doesn't change who you are. I'm a forever fan of you.

Susan Eichhorn Young

You are one of the strongest, most courageous women I know. You inspire through your ability to REMAIN HUMAN. You are simply priceless. Thank you for spirit and your friendship and whatever you set your mind to, IN YOUR TIME, will be yours. XO

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