Class I obesity patients still benefit from weight loss surgery

People with Class I obesity, who are generally not eligible for weight loss surgery, have seen gains from weight loss surgery, a researcher reported.

Patients with a BMI of 30 to 35 lost up to 20% of their initial BMI and were 45% more likely to be in remission from type 2 diabetes, 2 years after gastric bypass surgery or sleeve gastrectomy, according to Maria Altieri, MD, of East Carolina University Brody School of Medicine in Greenville, NC.

There were some differences for patients depending on the type of surgery they had, Altieri noted during a presentation at the American Society for Metabolic & Bariatric Surgery (ASMBS) virtual meeting.

Patients who had gastric bypass surgery were about twice as likely to be in remission from hyperlipidemia as those who had sleeve gastrectomy. In addition, approximately 50% of patients who underwent gastric bypass surgery were in diabetes remission after 2 years compared to 25% of those who underwent sleeve gastrectomy. The probability of remission of arterial hypertension after 3 years was 60% for gastric bypass and 50% for sleeve gastrectomy.

However, there was “no difference between BMI trajectories and remission of [type 2 diabetes] by comparing the two groups, ”the authors said.

“This study confirms the effectiveness of bariatric surgery in patients with class 1 obesity under real conditions and suggests that earlier intervention in patients with less severe disease should be considered,” said Altieri. “These data further support the need to update the current indication criteria.”

the Indications established by the NIH for bariatric surgery 30 years ago and, according to these guidelines, patients with a BMI 35, as well as an obesity-related disease such as diabetes, are eligible candidates, according to the authors.

For the retrospective study, Altieri and colleagues assessed patients from a clinical system’s electronic health records (EHR) database and identified 566 adults who had undergone Roux-en-Y gastric bypass surgery and 730 patients who underwent sleeve gastrectomy. The researchers then followed the patients in their EHR to determine the results. They reported that being younger, being female, and having obesity-related comorbidity were associated with greater weight loss.

ASMBS President Matthew Hutter, MD, of Harvard Medical School, Boston, noted in a statement that “Evidence continues to mount that people with lower BMIs may benefit from metabolic and weight loss surgery. This justifies a reassessment of the patient selection criteria so that all those who can benefit have access to this life-saving treatment. “

In one 2018 Position Statement, the ASMBS recommended that people with Class I obesity be offered optional weight loss surgery after non-surgical treatments have failed, as these “are often ineffective in achieving significant and long-term weight reduction. term and resolution of comorbidities “. Previously, the American Diabetes Association and others published a joint statement that weight loss surgery should be considered for patients with type 2 diabetes and a BMI of 30.0 to 34.9 if hyperglycemia is insufficiently controlled despite optimal treatment with oral or injectable drugs.

According to ASMBS data, an estimate 256,000 bariatric surgeries were performed in 2019, representing less than 1% of the surgical population currently eligible according to the BMI.

  • Ed Susman is a freelance medical writer based in Fort Pierce, Florida, United States.


Altieri and Hutter have not disclosed any relationship with the industry.

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