Researchers at East Carolina University Brody School of Medicine in Greenville, NC, have reported that patients with BMIs between 30 and 35, considered Class 1 obesity, lost up to 20% of their initial BMIs and were 45% more likely to be in remission of their type 2 diabetes two years after either gastric bypass or sleeve gastrectomy. The findings, ‘Outcomes in Patients Undergoing Bariatric Surgery with Class I obesity’, were presented at the American Society for Metabolic and Bariatric Surgery (ASMBS) 2021 Annual Meeting.
Gastric bypass patients were about twice as likely to be in remission from hyperlipidaemia than sleeve patients (50% vs. 25%), and the likelihood of remission of high blood pressure after three years was 60% for gastric bypass procedures and 50% for sleeve gastrectomy.
This real-world study included 566 gastric bypass patients and 730 sleeve gastrectomy patients with an average BMI 33. Health outcomes were obtained from an electronic health record database, which includes patients from different institutions throughout the US.
“This study confirms the effectiveness of bariatric surgery in patients with Class 1 obesity in real-world settings and suggests earlier intervention in patients with less severe disease should be considered,” said study co-author, Dr Maria Altieri, a bariatric surgeon at East Carolina University Brody School of Medicine.
Most health insurers still follow guidelines developed by the National Institutes of Health (NIH) in 1991 when bariatric surgery was only performed as an open procedure. These state that weight-loss surgery should be considered for patients who have a BMI > 40, or “in certain instances” in patients with BMIs between 35 and 40 who also have a serious obesity-related condition such as type 2 diabetes or high blood pressure. BMI is a measure of body fat based on a person's weight in relation to their height.
“The evidence continues to mount that people with lower BMIs can benefit from metabolic and bariatric surgery,” said Dr Matthew M Hutter, president of the ASMBS and professor of surgery at Harvard Medical School, who was not involved in the study. “This warrants a re-evaluation of patient selection criteria so that all those who can benefit, have access to this lifesaving treatment.”
In a position statement released in 2018, the ASMBS revised its recommendation from 2012 and recommended that individuals with a BMI between 30 and 35 be offered bariatric surgery as an option after failure of nonsurgical treatments though it notes that current nonsurgical treatments “are often ineffective at achieving major, long-term weight reduction and resolution of co-morbidities.”
Additionally in 2016, 45 professional societies including the American Diabetes Association, issued a joint statement that metabolic surgery should be considered for patients with type 2 diabetes and a BMI 30.0–34.9 if hyperglycaemia is inadequately controlled despite optimal treatment with either oral or injectable medications.