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What should you do according to your BMI?
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What should you do according to your BMI?

[What should you do according to your BMI?]

BMI under 25 kg/m2

There is no obesity.
The feeling of being overweight is not based on objective medical grounds. Some fat can nevertheless be present, even in slim persons. Weight-loss methods are not relevant for this group of people. The presence of fat is only associated with aesthetic problems (refer to the chapter on Plastic surgery, localised obesity)

BMI between 25 and 30 kg/m2

This is a simple excess of weight
However it should not be neglected because there exists an important statistical risk in this group for related diseases.
Here are some options available for treatment:

>> Common sense and simple dietetic and health principles
Include more physical activities in your lifestyle (walk at least 20 minutes a day, walk up the stairs etc.), avoid high calorie intake and foods with a high fat content, as well as snacking in-between meals and while watching TV.

>> Diet support
We shall not address this issue in detail here, nor favour one diet option over another. A lot of alternatives are available: balanced low-calorie diets, high-protein diets (combined with the former), dieting under surveillance in a health-institution etc. These require a nutritional evaluation and a food-intake study, as well as scheduled consultations with a dedicated physician.

>> Drugs
Drugs are usually prescribed for the complications linked to obesity. They are not designed as a first-line treatment of obesity. However, certain drugs can be prescribed by dedicated physicians (refer to the chapter on Drugs).

>> Digestive surgery
Digestive surgery is not indicated in patients with this BMI range.

>> Plastic surgery
Plastic surgery is performed after a large weight-loss of usually more than 20 kilograms, which does not apply to this range of BMIs, or to localised obesity (refer to chapter in Localised Obesity)

>> Intragastric balloon
The balloon is not a validated treatment for this range of patients. However, it has been proposed for BMIs of 27 to 30 where severe co-morbidities such as unstable diabetes were present, or after traditional therapies had failed.

BMI between 30 and 35 kg/m2

Here we are dealing with severe obesity, according to the definition of the World Health Organisation (WHO). Medical care is mandatory.
The main options for treatment are:

>> Common sense and simple dietetic and health principles
Include more physical activities in your lifestyle (walk at least 20 minutes a day, walk up the stairs etc.), avoid high calorie intake and foods with a high fat content, as well as snacking in-between meals and while watching TV.
These principles are always recommended, whatever therapeutic option has been chosen.

>> Diet support
We shall not address this issue in detail here, nor favour one diet option over another. A lot of alternatives are available: balanced low-calorie diets, high-protein diets (combined with the former), dieting under surveillance in a health-institution etc. These require a nutritional evaluation and a food-intake study, as well as scheduled consultations with a dedicated physician. Psychological support can also be necessary.

>> Drugs

Drugs are usually prescribed for the complications linked to obesity. They are not designed as a first-line treatment of obesity. However, certain drugs can be prescribed by dedicated physicians (refer to the chapter on Drugs).

>> Digestive surgery
Digestive surgery (gastroplasties and other operations) is not indicated in patients with this BMI range. It addresses only morbid obesity.

>> Plastic surgery
Plastic surgery is performed after a large weight-loss of usually more than 20 kilograms, provided the weight has stabilised (refer to chapter on Plastic Surgery)

>> Intragastric balloon
The balloon can be placed in this group of patients, but is not a validated nor a widely available treatment. Refer to the chapter on Other Treatments


BMI between 35 and 40 kg/m2

This range describes severe obesity, or even morbid obesity if associated with additional related diseases, such as diabetes, hypertension, hypercholesterolemia, cardiac or respiratory failures etc.

Whatever, the risk is important enough to require medical cares.

>> Common sense and simple dietetic and health principles

Include more physical activities in your lifestyle (walk at least 20 minutes a day, walk up the stairs etc.), avoid high calorie intake and foods with a high fat content, as well as snacking in-between meals and while watching TV. These principles are always recommended, whatever therapeutic option has been chosen.

>> Diet support

We shall not address this issue in detail here, nor favour one diet option over another. A lot of alternatives are available: balanced low-calorie diets, high-protein diets (combined with the former), dieting under surveillance in a health-institution etc. These require a nutritional evaluation and a food-intake study, as well as scheduled consultations with a dedicated physician. Psychological support can also be necessary.

>> Drugs
Drugs are usually prescribed for the complications linked to obesity. They are not designed as a first-line treatment of obesity. However, certain drugs can be prescribed by dedicated physicians (refer to the chapter on Drugs).

>> Digestive surgery
Digestive surgery (gastroplasties and other operations, refer to chapter on Digestive Surgery) may be indicated if there are co-morbidities, i.e. diseases related to obesity.

And provided:

- Usual therapies (diet support) have been carried out for at least one year under scrutiny, and have demonstrated evidence of failure.
- The patient is aged over 18 years and less than 60 years.
- The last significant weight-loss (more than 5 kilos) dates back to more than 6 months, ideally more than one year.
- The onset of obesity dates back to at least 5 years.

If the operation is chosen, one must emphasize the need for psychological and nutritional support, which are mandatory before operation and in the long-term follow-up.
Because of its own risks, surgery is never a first choice therapy, and even less a necessary and urgent option.

>> Plastic surgery
Plastic surgery is performed after a large weight-loss of usually more than 20 kilograms, provided the weight has stabilised for one year (refer to the chapter on Plastic Surgery)

>> Intragastric balloon

The balloon can be used for this group of patients, but is not a validated or largely available treatment. Refer to the chapter on Other Treatments


BMI of more than 40 kg/m2


Here we are dealing with morbid obesity, which is a life-threatening burden, and dramatically increases the risk for cardiovascular or metabolic diseases (diabetes). Stronger treatments are required. Among them surgery has emerged and become an interesting option, although it should be chosen with caution.

>> Common sense and simple dietetic and health principles
Include more physical activities in your lifestyle (walk at least 20 minutes a day, walk up the stairs etc.), avoid high calorie intake and foods with a high fat content, as well as snacking in-between meals and while watching TV. These principles are always recommended, whatever therapeutic option has been chosen.

>> Diet support
We shall not address this issue in detail here, nor favour one diet option over another. A lot of alternatives are available: balanced low-calorie diets, high-protein diets (combined with the former), dieting under surveillance in a health-institution etc. These require a nutritional evaluation and a food-intake study, as well as scheduled consultations with a dedicated physician. Psychological support can also be necessary.

>> Drugs
Drugs are usually prescribed for the complications linked to obesity. They are not designed as a first-line treatment of obesity. However, certain drugs can be prescribed by dedicated physicians (refer to the chapter on Drugs).

>> Digestive surgery
Digestive surgery (gastroplasties and other operations, refer to chapter on Digestive Surgery) may be indicated if there are co-morbidities, i.e. diseases related to obesity, or just because of the BMI.

And provided: - Usual therapies (diet support) have been carried out for at least one year under scrutiny, and have demonstrated evidence of failure.
- The patient is aged over 18 years and less than 60 years.
- The last significant weight-loss (more than 5 kilos) dates back to more than 6 months, ideally more than one year.
- The onset of obesity dates back to at least 5 years.

Some reservations can be made regarding the placement of a prosthetic treatment under the age of 40 years. If the operation is chosen, one must emphasise the need for psychological and nutritional support, which are mandatory before operation and in the long-term follow-up.

Because of its own risks, surgery is never a first choice therapy, and even less a necessary and urgent option.
For more details, refer to chapter Digestive Surgery.

>> Plastic surgery

Plastic surgery is performed after a large weight-loss of usually more than 20 kilograms, provided the weight has stabilised for one year (refer to the chapter on Plastic Surgery)

>> Intragastric balloon
The balloon can be used for this group of patients, but is not a validated or largely available treatment. Refer to the chapter on Other Treatments


BMI of more than 50 kg/m2

We are dealing with what is called 'superobesity', with a maximum risk for health. In the United States, where such cases are not rare, one has even defined a 'triple obesity', with BMI above 60.

Refer to the description on morbid obesity (BMI above 40), as the criteria are the same. Let us point out some facts:

>> Digestive surgery

Digestive surgery is often a realistic procedure for such patients, although there are numerous risks of failures.

>> Reconstructive surgery
It is almost always necessary to perform reconstruction after huge weight-loss, because very large amounts of skin remain.

>> Intragastric balloon
The balloon is obviously not suitable for superobese-patients. However, some teams have advocated it in two cases:- When one wishes a rapid and significant weight-loss in order to facilitate a requested surgical procedure that would be too risky because of the patient's weight (e.g. hip replacement).
- Before a specific bariatric procedure, such as a gastroplasty, in order to ease its technical performance and the follow-up. This indication is under scrutiny.


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