Do you have resources on the scientific basis for BMI's efficacy as a health indicator? Comparing to linear measurements like temperature and distance seems a little apples-and-oranges when BMI is attempting to do something different, which is to reduce a fairly complex system to a single number.

> I'd like to see those statistics.

https://www.ncbi.nlm.nih.gov/pubmed/10449014

"Data from the scientific community indicate that a 15-wk diet or diet plus exercise program produces a weight loss of about 11 kg with a 60-80% maintenance after 1 yr. Although long-term follow-up data are meager, the data that do exist suggest almost complete relapse after 3-5 yr."

And that's 11kg… the situation described above is 90kg. You're essentially telling someone to go away and come back after 2+years of dieting to get medical care. Don't you think that seems unrealistic?

> Do you have resources on the scientific basis for BMI's efficacy as a health indicator?

http://www.cdc.gov/healthyweight/assessing/bmi/adult_bmi/ind...

http://www.cdc.gov/healthyweight/assessing/bmi/adult_bmi/ind...

> > > If you look at the statistics on weight loss success rates, asking a 500lbs person to lose 200+lbs before you're willing to treat their disease with actual evidence-based medicine—looking at symptoms, pathology, etc—is tantamount to outright denial of care.

> > I'd like to see those statistics.

> "Data from the scientific community indicate that a 15-wk diet or diet plus exercise program produces a weight loss of about 11 kg with a 60-80% maintenance after 1 yr. Although long-term follow-up data are meager, the data that do exist suggest almost complete relapse after 3-5 yr."

This in no way indicates how many patients with knee and hip issues are able to solve those knee and hip issues simply by losing weight.

> And that's 11kg… the situation described above is 90kg. You're essentially telling someone to go away and come back after 2+years of dieting to get medical care. Don't you think that seems unrealistic?

No, I'm not telling someone to go away and come back after 2+ years to get medical care, I'm prescribing medical care that will take 2+ years.

Weight loss isn't denial of care; weight loss is the care.

There are plenty of forms of treatment that take a long time. If a doctor prescribes a course of medication that takes 2 years before trying surgery because it will solve the problem for most people and is lower-risk, you wouldn't complain about that, or call it denial of care. But in fact, weight loss is safer than most medicines--weight loss for an obese person has almost no negatives.

I posit that the only reason you're objecting to weight loss as treatment is that you've formed your opinion based on identity politics rather than medical efficacy.

Weight loss is a result of a proper treatment. A result.

Care is getting the obese person to lose weight. Which is hard, harder than dealing with hard drugs. Dieteticians, who are supposed to be specialists, fail hard at care. GP doesn't even know where to start.

So let's fix what is broken. If a person cannot eat, they are fed, right? That is a task for a properly trained nurse.

But I don't know of a doctor who wants to provide essentially more than daily care and effective one to begin with.

And doctors do not like to feel like failures.

I agree, we need better help for weight loss.

However, that's not what most people here are arguing for. The specific case here is a complaint that people are denied surgery, and people feel that this is denial of care; that is, people are arguing that we should perform knee and hip surgeries on obese people, even though weight loss would be a much safer treatment.

Well, I know a few people with damaged joints. Weight loss helps but does not fix the problem. The main thing is if your joint are damaged due to overload and not some other issue, surgery may be less effective or only temporarily effective.

The joints can and do regenerate except from chronic problems. Unfortunately, obesity is one, just losing weight does not fix joints as quite a few long time former weight lifters can attest.

From the article: "The group concluded that heavy patients should first be counseled to lose weight because a lower weight reduces stress on the joints and can alleviate pain without surgery." (emphasis mine)

I don't have any reason to disbelieve you about your friends, but your friends do not represent all obese people, and in losing weight does fix joints some percentage of the time. Given the alternative is surgery, which kills the patient some percentage of the time, I don't think there's a lot of debate to be had here.

It is true. Counselling is not good enough though. Given how ineffective it is, it is essentially permanent denial.

Moreover, there are other issues to verify, say, a person born with hip dysplasia should be treated regardless of weight as weight loss will never fix the underlying problem.

Also aching hip joints quite effectively prevent many kinds of exercise, which does not help with weight loss at all.

Without an effective alternative course of action, the surgery may be the one remaining effective measure.

> It is true. Counselling is not good enough though. Given how ineffective it is, it is essentially permanent denial.

I disagree--in fact, I think a large part of the problem here might be this very conversation. It's unclear how much of the reason that counseling is ineffective is because obesity has become an identity politics issue. If you tell someone that it's okay to be fat, and go so far as to say that obesity isn't the cause of their problems, it's a lot easier for them to just cry "denial of care!" than to actually lose weight. The first step to solving the problem is admitting it is a problem, and fat acceptance is actively impeding that part of the recovery process.

I don't have personal knowledge to say which way the direction of causality goes: whether identity politics causes counseling to be ineffective, or whether counseling is inherently ineffective and therefore identity politics are right. But I think that doctors are the ones with the most information to decide that, not identity politics activists.

What I do know is that even if counseling is only 10% effective, it's far less dangerous than surgery, so it should always be the first choice. If someone tries weight loss programs for a few years and fails to lose weight, then maybe it makes less sense to deny surgery (this would be a situation I'd be interested in hearing medical opinions about). But I see no evidence that this is actually happening. What I'm seeing is people saying that demanding people try weight loss first is equivalent to denial of care, and that people should be allowed to get surgery without even trying to lose weight.

And while this firmly steps outside science, I think obesity makes sense to treat as an addiction problem. I've been treated successfully for alcoholism via a program which equally has very low success rates to weight loss programs. My personal experience with this is that, as identity politics say, it makes little sense to shame people for their addiction or to discriminate against people because of their addiction in cases where it doesn't affect their ability to perform. Blaming me for my addiction or punishing me for my addiction didn't work. However, what also didn't work was living in denial that I was an addict and that my addiction was a problem. I don't blame myself for my addiction, but I did need to take action and participate in my treatment.

You wouldn't give someone with alcoholic hepatitis a liver transplant unless they stopped drinking, and you shouldn't give an obese person a hip replacement unless they lose weight.

Most of the people that I know who have needed hip or knee surgery are thinner people. One’s occupation and/or recreation activities are far more likely to have an impact on whether you need knee surgery than one’s mass (one gentleman I know who had to have both knees replaced was at most 65 kilo and about 165cm—140lb and 5'5"—but had played tennis all his life and had a job which required using his knees often).

I know, anecdotes are not data, but there is essentially no data that supports the claims made about BMI, and there are known measurements that are more effective than this grossly ineffective ratio that is loved pretty much only by insurance underwriters.

> Most of the people that I know who have needed hip or knee surgery are thinner people.

I'm proposing that weight loss is an effective and reasonable treatment for hip or knee problems in obese people, so this observation is consistent with my proposition.

> I know, anecdotes are not data, but there is essentially no data that supports the claims made about BMI, and there are known measurements that are more effective than this grossly ineffective ratio that is loved pretty much only by insurance underwriters.

People are focusing in on BMI as being an inaccurate measurement of fatness, but notably all the cases noted where people treated with weight loss instead of surgery are people who are fat by any measurement you want to pick. Look at the pictures, or read how the person interviewed says, "Do you think I don't know I'm fat?" Can you point to cases where someone who isn't fat was denied surgery due to their BMI?

When I was in the best shape of my adult life, I weighed 175, with 10% body fat (measured with calipers) and a size 30 waist. I wasn't overly into lifting weights but did a lot of cardio. My BMI was 30 - obese.

5 years later. I do about 3 hours of cardio a week, I weigh 185 and my waist is about 32. My BMI is 31.8. No doctor has ever looked at me and said I need to lose weight.

BMI is completely bunk in my case.

1. It's true that BMI doesn't provide a complete picture of a healthy fat percentage, but weight and waist measurements provide even less information, so I'm not sure why you would present that information as if it contributed to your point.

2. Caliper fat measurement is pretty accurate if done correctly, but it's also hard to do correctly.

3. In your own words, no doctor has ever looked at you and said you need to lose weight. This seems to indicate that while BMI isn't always an indicator of health, doctors are capable of identifying the exceptions.

You're 5'3" and weighed 175? You must be built like a tank

5"4. But like I said. I don't lift weights anymore at all. But most people assume I do.

As far as the caliper body fat test. It was done using 6 parts of the body.