Outcomes of bariatric surgery in patients with body mass index <35 kg/m2

doi:10.1016/j.soard.2011.08.012

Surgery for Obesity and Related Diseases

Volume 8, Issue 1, January–February 2012, Pages 25-30

https://doi.org/10.1016/j.soard.2011.08.012 Get rights and content

Abstract

Background

Patients who are categorized with class I obesity have a body mass index (BMI) of 30–34.99 kg/m². This population of patients has a predisposition to diabetes, hypertension, and dyslipidemia. The aim of the present study was to investigate the improvements of these co-morbidities in a class I obese population that had undergone a bariatric procedure.

Methods

After internal review board approval and with adherence to the Health Insurance Portability and Accountability Act guidelines, a retrospective review was performed of a prospectively maintained database of 42 class I obese patients who underwent a bariatric procedure at our institution during a 10-year period, from February 2000 to May 2010. The fasting glucose level, glycosylated hemoglobin level, lipid profile, initial weight, and BMI were measured in the preoperative and postoperative periods.

Results

Our patient population consisted of 30 women and 12 men, with a preoperative mean BMI of 33.9 kg/m². Laparoscopic sleeve gastrectomy was performed in 24 patients (57%), laparoscopic Roux-en-Y gastric bypass in 8 (19%), and laparoscopic adjustable gastric banding in 10 (24%). Of these 42 patients, 25 (60%) had type 2 diabetes, 1 patient was glucose intolerant, 27 (64%) had arterial hypertension, 25 (60%) had dyslipidemia, 17 (40%) had sleep apnea, and 8 (19%) had osteoarthritis. The postoperative findings included a mean BMI of 26.5 kg/m² and a mean weight loss of 41.4 lb. Of the 25 diabetic patients, 5 (20%) gained remission and 12 (48%) improvement of their diabetic status. The single patient with glucose intolerance showed improvement. Of the 27 patients with arterial hypertension, 9 (33%) showed remission and 13 (52%) improvement. Dyslipidemia resolved in 5 patients (20%) and improved in 13 (52%). Obstructive sleep apnea resolved in 10 (59%) and improvement was seen in 1 patient (6%). Finally, osteoarthritis resolved in 1 patient (12%) and improved in 5 (63%).

Conclusion

Bariatric surgery can significantly improve or resolve co-morbid metabolic conditions in patients with class I obesity.

Section snippets

Methods

After institutional review board approval and following Health Insurance Portability and Accountability Act guidelines, we performed a retrospective review of a prospectively maintained database and medical chart review of 42 class I obese patients who had undergone a bariatric procedure from February 2000 to May 2010.

The population reviewed included 30 women and 12 men with a preoperative mean BMI of 33.9 kg/m². The type of procedure was consensually agreed on by the patient and surgeon. Of

Results

Of our 42 patients, 1 patient had 6 years of follow-up, 14 completed 24 months of follow-up, 2 patients completed 18 months of follow-up, 6 patients completed >12 months of follow-up, 17 patients completed <12 months of follow-up, and 2 patients were lost to follow-up. Follow-up telephone calls were made in July 2010, and the following information was collected: current weight and improvement or remission of co-morbidities, such as diabetes, hypertension, dyslipidemia, obstructive sleep apnea,

Discussion

The mean preoperative BMI for our patient population was 33.9 kg/m². In our patient series, the BMI ranged from 30 to 35 kg/m², and all patients benefited from bariatric procedures, with the exception of 1 patient in the LAGB surgery group. We believe that the levels of illustrated improvement and remission of co-morbidities, along with the sustained weight loss, make this type of surgery suitable and safe for patients with a BMI of 30–35 kg/m² with ≥1 co-morbidities, leading to an improvement

Conclusion

Bariatric surgery is the most effective treatment resulting in the long-term reduction of body weight and should at least be considered for all patients with a BMI >30 kg/m² with existing obesity-related co-morbid conditions. Our study has shown that bariatric surgery is not only efficacious in the treatment of diabetes mellitus but also leads to improvement or remission of other obesity-related co-morbidities. From our series of patients, it appears that this type of surgery can be safely

Disclosures

Dr. Rosenthal received educational grants from Ethicon, Covidien, Storz, and Synovis; is an advisory board member, consultant, and speaker for Ethicon; an advisory board member and stockholder for Safestich Inc; and advisory board member for Reshape and Vybrint. Dr. Szomstein is a consultant for Ethicon and Covidien. Drs. Gianos, Abdemur, Fendrich, and Gari have no disclosures to report.

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Bariatric surgery is an effective treatment for severe obesity. However, there has been an evolving role for bariatric surgery as a primary treatment in the management of class I obesity.
We aimed to assess the safety of surgery by directly comparing surgical outcomes of laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB) in class I obesity (body mass index [BMI] 30–35 kg/m²) with those with class II obesity (BMI 35–40 kg/m²) and higher (BMI >40 kg/m²) using an analysis of a large-scale matched-patient cohort analysis.
Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database, United States and Canada.
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Initial analysis included 274,091 patients. Propensity-matching resulted in 9104 patients for analysis in each of the class I and class II and higher groups. The overall major complication rate between the 2 matched groups was 3.9% for class I and 3.5% for class II and higher (P = .11). We did not find that class I obesity was associated with an increased risk of 30-day complication or death.
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Body image is a multidimensional, dynamic and socially influenced construct. The aim of this research was to analyze the experiences associated to body image in women with obesity type I after two–five years undergoing bariatric surgery. In this qualitative-descriptive study were included 20 women (21–49 years old) with obesity type I, 13 of them with regaining weight. Data were obtained through semi-structured interview and was analyzed based on six categories: Emotions associated with body, body satisfaction and like/dislike with body parts, avoidance of daily activities because of the body figure, discomfort with the own body with the opposite sex/general people, comparison with other women considering the body figure, and perception associated to the minimum weight. Regarding the patients who did not regain weight, they have a positive emotionality and general satisfaction with their body image. As a general conclusion, an increase in body satisfaction was identified, due to the decrease in body volume. However, the dissatisfaction persists, moving to specific areas and aspects of the body. Therefore, it is confirmed that body weight reduction does not necessarily predict the reduction of body dissatisfaction.
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There was also variability in the method of weight and co-morbidity reporting. Laparoscopic adjustable gastric banding, sleeve gastrectomy, gastric bypass, and biliopancreatic diversion are all represented in the current literature (Table 3) [31–46]. Weight loss.
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Original articleOutcomes of bariatric surgery in patients with body mass index <35 kg/m2

Abstract

Background

Methods

Results

Conclusion

Section snippets

Methods

Results

Discussion

Conclusion

Disclosures

Atherosclerosis

Surg Obes Relat Dis

Etiology and natural history of obesity

Obesity and overweight

Diabetes

Body mass index and mortality in a prospective cohort of US adults

N Engl J Med

Original article
Outcomes of bariatric surgery in patients with body mass index <35 kg/m²