Dear Editor,
It is with pleasure that we receive the comments from Patel et al. (1) about our recently published article (2). We agree with the authors that Body Mass Index (BMI) might not be the best categorization of obesity for all purposes. However, we believe it is incorrect to state this is a fatal flaw in ours or any study, as on average, BMI across populations correlates with more precise measures of body fat (3). In fact, that represents the reason why clinicians have adopted BMI as the standard approximation for obesity in their daily clinical practice.
While more granular measures of obesity and further investigations of their impact in severity scoring may prove to be of great value, it would be impractical to apply such obesity phenotypes in this kind of initial assessment, as it would neither reflect current clinical practice, nor represent obtainable data for this purpose.
Our study answered a commonly asked question among intensive care physicians, utilizing a substantial amount of data to corroborate the findings. Nevertheless, we also believe that a broader and more detailed analysis of the clinical impact of obesity measures in decision support for clinically ill patients would be a great addition to the literature and we look forward to future publications on that subject.
Acknowledgments
Copyright form disclosure: Drs. Celi and Johnson received support for article research from the National Institutes of Health. The remaining authors have disclosed that they do not have any potential conflicts of interest.
Footnotes
Conflict of Interests Disclosures: Nothing to declare
References
- 1.Patel Jayshil J., Manpreet Mundi: One Size Does Not Fit All - The Implications of Using BMI in Critical Care Outcomes Research. Crit Care Med 2019; in press [DOI] [PubMed] [Google Scholar]
- 2.Deliberato RO, Serpa Neto A, Komorowski M, Stone DJ, Ko SQ, Bulgarelli L, Rodrigues Ponzoni C, de Freitas Chaves RC, Celi LA, Johnson AEW: An Evaluation of the Influence of Body Mass Index on Severity Scoring. Crit Care Med 2019, 47(2): 247–253. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3.Adab Peymane, Pallan Miranda, and Whincup Peter H.: Is BMI the best measure of obesity? British Medical Journal 2018, 361:k2293. [DOI] [PubMed] [Google Scholar]