I had a patient recently want to do surgery and her BMI is 36. Our outpatient surgery center has a cut off for BMI, and this was too high. I cannot do her surgery.
I understand the frustration and anger that comes with this. There is a reason though that there is a BMI cutoff. First and foremost it is for safety. The science on BMI and complications is VERY clear.
- Study after study shows higher BMI correlates with higher complications in almost every area: nausea, DVT, pulmonary embolus, infection, fat necrosis, tissue loss, wound healing issues, need for reoperation, and poorer scarring. I just did a blog about breast reconstruction, and they showed a clear correlation with BMI, starting at a BMI over 25. And the complications went up as the BMI went up. They found a BMI of 32 or more was as risky as operating on a current smoker. They found BMI was more predictive of complications than age, history of diabetes, or smoking. (!!!) And the numbers were not small percentages of issues. Many were 20% or higher.
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- They found there were distinct levels of complication increases:
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- BMI 30 any breast complication
- BMI 35 unplanned reoperation
- BMI 40 fat necrosis
- BMI 35 unplanned reoperation for wound breakdown
- BMI 30 any infection
- BMI 25 infection requiring oral antibiotics
- BMI 35 infection requiring IV antibiotics
- BMI 35 mastectomy flap necrosis
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- They found there were distinct levels of complication increases:
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- Higher BMI correlates generally with other general health risks: high blood pressure, diabetes, cardiac risk.
- Losing weight after surgery can ruin some results, particularly for any surgery which is tightening the skin- breast lift, breast reduction, and abdominoplasty.
- If your BMI is high, you may have sleep apnea and an obstructed airway. Please take this test to see if you may have unknown sleep issues HERE. Why do I care about apnea? First, it makes your airway and intubation for surgery harder and riskier. Second, apnea affects oxygenation to your tissue. This impairs healing, scarring, infection risk. And last, most pain medications cause respiratory depression. Apnea already has respiratory issues. The most dangerous time is when sleeping at night. This can be made better by weight loss and/or CPAP.
In the past, we didn’t have many choices to help people. Diet, exercise, 10,000 steps, intermittent fasting. To ask someone to do a surgery like gastric stapling or a bypass? Those have costs, it is a surgery, and there can be eating and absorption issues.
But now we have much easier weight loss methods. No matter what your feelings are, weight loss using medications like semaglutide and tirzepatide are great options. I am not recommending this for people who want to lose 10 pounds and are at a normal BMI. This is specifically for those with BMIs over 30 or BMI over 27 with other medical issues. IT WILL MAKE YOUR SURGERY SAFER AND YOUR RESULTS BETTER to lose the weight prior. These should be administered by a clinic or doctor familiar with these medications (avoid complications, side effects, muscle loss, etc). It should be done with evaluating your diet, health issues, and exercise.
Other considerations:
- Realistic weight loss is 5-7 pounds/month. When planning for timelines, take this into account.
- I do not support dieting with severe caloric restriction. These tend to fail (read the Obesity Code book) and send you into surgery depleted of the protein and nutrients which help you heal and fight infection. It has been shown protein loading one month prior to and one month after surgery has STATISTICALLY have lower infection rates and prettier scars.
- Weight should be STABLE. If your weight is yo-yoing or is increasing, you do not have good systems in place. You must be stable to do surgery.
- Even if you do not end up with a big complication from higher BMI, for sure you will have higher rates of healing issues- little infections along the suture line, fat necrosis, spitting sutures, uglier scars, widened scars, etc
I am not judging. I come from a family riddled with obesity, and the genetic component is real.
SAFETY and RESULTS. That should be your focus when doing elective surgery. The science is clear. BMI of 30 or higher is considered obese, 35 or higher severe obesity. Weigh yourself (I will weigh you, the operating room will weigh you), so get on that scale to see your number. For a calculator, click HERE>