May be the ratio abominal waist / height

since GLPI inhibitors are effective in reducing weight in patients with BMI over 35 and 40 kg/m2ONE CAN TO START WITH use either exenatide and see the results or other GPI inhibitors and only if not tolerated any bariatric surgery and as far as ariatric surgery is concerned it to works by lowering GLP1 and PYY1 polypeptides and initially laparoscopic methods devised and now trials are being made to leave a baloon foe 12 months by endoscopy to replace bariatric surgery for 12 months to achiebve the same egffect of lowering GLP1 znd PYY1 IN NANE OF MEDIGEST

http://www.ncbi.nlm.nih.gov/pubmed/19853906

BMI has become the integral part,however waist Hip ratio is good.Bariatric surgery  is very effective by modulating the fore gut and hind gut incretins.

We all know that BMI is far from perfect, but in our bariatric all days activity it is the best known index. Of course the borders of BMI 35 and 40, according to the NHANES, are arbitrary. The Edmonton Obesity Surgery Score (EOSS) by Sharya Sharma is far more interesting from the medical point of view, because co-morbities weigh more than the bare body weight for an appropriate bariatric indication.

I use the EOSS since a couple of years regularly, beside the ASA for the overall risk.

I so much agree that BMI is far from perfect.... but it makes us reach standardization. The W/H ratio is always part of anthrometric evaluation pre bariatric, and is part of the regular follow-up. Of course there are people with DM and BMI over 30 that are eligible for bariatric surgery in a few centers.

But leave alone the BMI, the basis for the success and this must be emphasized at all times by the bariatric team, is siginificant lifestyle modification and consistent follow-up. 

You can see in two papers I published in Obesity Surgery.

Evidence suggests that for individuals of Asian origin, bariatric surgery should be offered at a lower BMI than other populations. On the other hand, some people can have apparently good (at least metabolic) health with a BMI above 35 (even above 40), while others have type 2 diabetes at a BMI below 30! I agree with Renward Sebastian Hauser, that the Edmonton Obesity Surgery Score (EOSS) by Sharya Sharma is far more interesting, because obesity comorbities "weigh" more than the body weight per se.