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Should we use BMI as a selection criterion for bariatric surgery?

Body Mass Index (BMI) is part of us. We grew up with it. We learnt it. We use it every day. We define obesity by it. We devise guidelines according to it. As such, BMI seems to have acquired an untouchable, almost mythical status since its conception by Quetellet in the 19th Century. 
 
BMI has been in use since 1985 as a clinical tool for patients with obesity following a National Institutes of Health Consensus (1). Use of BMI cut-off values as a selector for bariatric surgery was first introduced in 1991 (2). Despite the widely ubiquitous adoption and apparent acceptance of BMI as a clinically utilitarian variable, BMI is inherently flawed. If we want to understand the nature of obesity, and the inherent flaws associated with BMI as a concept, we need to step outside of the matrix. We need to challenge our own dogmatic beliefs and return to first principles.