BARIATRIC SURGERY: Beneficial in the early stages of obesity?

BARIATRIC SURGERY: Beneficial in the early stages of obesity?

Bariatric surgery, also known as “metabolic surgery,” or weight loss surgery, such as gastric bypass and sleeve gastrectomy (or longitudinal gastrectomy), has been shown to be the most effective and long-lasting treatment for severe obesity. . This intervention improves or even resolves chronic diseases such as type 2 diabetes, heart disease, and high blood pressure while promising a safety profile comparable to that of the most “innocuous” and most effective surgeries. common.

Weight-loss surgery is still usually reserved for people with severe obesity, who are either overweight> 30 pounds or have a BMI> 35 and a comorbidity of obesity.

Finally, obesity is known to be linked to more than 40 diseases, including type 2 diabetes, hypertension, heart disease, stroke, osteoarthritis, and at least 13 different cancers. high death rate. According to the ASMBS,

1% of patients eligible for weight loss surgery can actually benefit from it in a given year.

The study However, just over 8,100 weight loss procedures, either laparoscopic sleeve gastrectomy or gastric bypass, have been performed in the United States from 2015 to 2019 in patients with a BMI of less than 35 kg / m2. or suffer from class I obesity.

  • This represents about 1% of the more than 760,000 bariatric surgeries performed;
  • the results of these patients with low BMI who underwent weight loss surgery are quite comparable to those of patients with morbid and / or more severe obesity;
  • there are few differences in both health and safety outcomes between patients with lower and upper BMI and between different weight loss procedures;
  • however, a comparison of the results with the 30-day sleeve gastrectomy revealed that patients with low BMI underwent shorter procedures, remained hospitalized for less time, and were less likely to have a complication or be readmitted to the hospital in 30 days, vs patients with higher BMI.

Lower the eligibility threshold: Researchers are calling on health agencies to lower the eligibility and BMI threshold to 30 for patients with obesity comorbidity, such as type 2 diabetes: “The current guidelines are outdated and do not reflect decades of data on the safety and efficacy of metabolic and bariatric surgery. Nor do they consider the development of laparoscopic procedures that make surgery less invasive and safer, ”says Dr. Theresa Jackson, one of the study’s lead authors, a surgeon and research expert in surgery. bariatric at the Kaiser Permanente (South Sacramento, California).

Consider diabetes: In 2016, 45 learned 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 between 30.0 and 34.9 if their hyperglycemia is not sufficiently controlled with treatment with oral or injectable drugs.

The authors confirm metabolic or bariatric surgery as the most effective and long-lasting treatment for the most common comorbidities of obesity, including type 2 diabetes.

“These obese patients with lower BMI should not be forgotten.”

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