Beyond BMI: Shawn Davis, MD, on Why Adiposity Is the Better Measure for Managing Obesity

Shawn Davis, MD, a physician at Kelsey-Seybold Clinic specializing in obesity care, addresses why the health care system needs to move beyond body mass index (BMI) as the primary lens for evaluating obesity.

BMI, she argues, is too broad a category to capture what's happening metabolically in a patient's body. The more meaningful measure is adiposity, which is the actual amount of fat mass and adipose tissue present. It’s the degree of adiposity, she explains, that actually drives hormonal disruption and metabolic dysfunction. As Davis puts it, focusing on adiposity "would give us a better insight on how to make long-term changes in patients’ health." This reframe has real implications for how health systems invest in diagnostics, care pathways, and treatment tools, pushing toward more individualized, metabolically informed approaches rather than weight-based thresholds.

Davis identifies reversing comorbidities as the most actionable near-term target. Rather than chasing a patient's ideal body weight, she emphasizes that even modest weight loss in the 5% to 15% range can reduce hypertension, improve dyslipidemia, and reduce the severity of sleep apnea. These are conditions with well-documented downstream costs, particularly at the inpatient level. Reducing hospitalizations tied to cardiovascular disease and other obesity-driven complications represents a clear path to bending the cost curve. This aligns with broader research showing that obesity-related conditions account for a significant share of US health care spending, with some estimates placing the total annual economic burden, including lost productivity, well above $1 trillion.¹

Reference

1. Waters H, DeVol R. Weighing down America: the health and economic impact of obesity. Milken Institute. November 1, 2016. Accessed April 3, 2026. https://milkeninstitute.org/content-hub/research-and-reports/reports/weighing-down-america-health-and-economic-impact-obesity