The Body Mass Index, or BMI, is a calculated number that is determined by dividing ones weight by their height, and has been used for many years as the standard by which body weight is measured. The actual formula uses weight in Kilograms and Height in Meters, but this has been converted to pounds and inches on most BMI charts in the US. It has been determined that a BMI of 25 is “normal,” as this is the weight which has been shown to be associated with the least amount of medical problems and longest life expectancy. At a BMI of 25-30, one is considered “overweight.” This is not particularly dangerous although does show a mild increase in the incidence of medical consequences. At a BMI of 30-40 one is considered “obese” at which point the diseases associated with obesity become much more prevalent and a decrease in life expectancy is demonstrated.
Once this process reaches the level of “morbid obesity”, defined as a BMI of greater than 40, then the weight causes progressive and extensive damage to the body. With this comes an extensive list of medical problems (or co-morbidities), and a markedly shorter life expectancy. For example, every five unit increase above (the most healthy) BMI of 25 translates into a 40% increase in death from heart disease and a 10% increase in cancer death. This results in a four-fold increase in cardiac death and two-fold increase in cancer death. For those with morbid obesity, life expectancy averages ten years less than normal. Indeed, the collective risk of premature death of Americans with a BMI greater than 40 is 6-12 fold that of the non-obese population (see Obesity In America). Further, early death is only one potential consequence. The social, economic and psychological effects of obesity are real and are especially devastating. Studies show that those with morbid obesity are looked upon with disdain and prejudice. Not only considered less attractive, but also less motivated and intelligent. Studies show blunted opportunity for advancement and lesser earning potential in the workplace as well as increased strain on personal relationships. Obese persons clearly represent one of the last people groups in the U.S. to suffer open, accepted bias. So for most, morbid obesity leads to a shorter, unhealthier and less satisfying life - a truly devastating disease.
Given these devastating consequences The NIH determined in 1991 that those who have Morbid Obesity should be treated surgically. The specific criteria proposed include anyone with a BMI of 40 or greater, but also those with a BMI of 35 – 40 when associated with “significant” medical problems s/a Diabetes, Hypertension, Heart disease, Obstructive Sleep Apnea, or extensive joint disease. These criteria are the same ones used today all major insurance carriers as well as Medicare.