World Heart Day: What Should Patients Measure as Success Beyond BMI?
Sept. 14 2026, Updated 12:04 p.m. ET
Weight loss is something that can be easily measured. Step on a scale and the numbers will give you an answer. However, for people with obesity who are being treated for it, their weight can become so dominant that they miss out on other important changes that are taking place in their bodies.
This is why it is important to ask, especially around World Heart Day on 29 September, a different question: what has changed in your health besides the numbers on the scale?
The Scale Is Only One Marker
Assoc. Prof. Dr. Nadir Adnan Hacim, an Obesity and Metabolic Surgery specialist at Erdem Hospital says BMI remains useful as a screening tool but should not be the only measure of progress. “In order to assess the health of our patients with obesity, we monitor their blood pressure, blood sugar, liver function, waist circumference, as well as their sleep and physical activity before we decide whether or not the amount of their medication needs to be adjusted.
In addition to weight loss, it is very important to assess the improvement in the health of patients with obesity during treatment. For example, for someone with insulin resistance or type 2 diabetes, improvement in HbA1c may be one of the most meaningful changes. For another person, the major gain may be lower blood pressure, less breathlessness on stairs, or improved sleep apnea symptoms.
A reduction in the abdominal fat of a person is also important, as it decreases the cardiometabolic risk of that person. In fact, a person may experience a meaningful reduction in waist size even when the scale seems to be moving more slowly than expected.
“Some of the patients get very upset because they only lose 2-3 kg of weight in a month,” Dr. Hacim says. “Then we look at the rest of the parameters. Their blood glucose levels may have dropped, they may be taking a smaller dosage of blood pressure medication, they may be sleeping better and are able to walk for longer periods of time. These are not secondary outcomes; these are the results we want to see as part of the treatment.”
Weight Loss Can Change Heart Risk in Several Ways
Obesity is associated with a variety of diseases including hypertension, abnormal blood lipids, type 2 diabetes, sleep apnea and fatty liver disease. All of these contribute to cardiovascular health. Therefore, by treating obesity, a number of these problems can be improved.
Long-term follow-up of individuals who have undergone metabolic and/or bariatric surgery has shown significant improvement in diabetes control as well as durable weight loss. A JAMA analysis, which followed individuals with type 2 diabetes for up to 12 years after their bariatric surgery, found that these individuals lost more weight in the long term. The individuals who had undergone surgery also had substantially lower use of insulin at seven years post-op.
“We are not treating BMI in isolation,” Assoc. Prof. Dr. Nadir Adnan Hacim says. “We are treating a person whose heart, liver, sleep, joints and metabolism are all affected by weight in different ways.”
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Quality of Life Counts Too
Some of the most important outcomes are difficult to capture in a laboratory result. It is important for a patient to be able to go for a longer walk, exercise more, play with children, and travel more comfortably.
“Success in the treatment of the person with obesity should become more personal as the treatment continues. Initially, the main goal of the patient is to lose weight. But in subsequent stages of the treatment, the main question to ask would be: What can you do now that you could not do before? What risks have actually decreased?”
So, for people who are already being treated for obesity, World Heart Day is a good opportunity to think about more important things to measure than BMI. It is important to evaluate the strongest outcome, which often involves much more than the number on the scale.
