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Gastric bypass may have role in less obese

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28th Annual Meeting of the ASMBS

A recent study linking gastric bypass surgery with significant weight loss and high rates of diabetes remission in patients who have a BMI of 35 or less indicates that the procedure may be an effective treatment option for this population.

Data presented at the 28th Annual Meeting of the American Society for Metabolic and Bariatric Surgery revealed that patients with a BMI of 35 or less lost 167.1% of their excess weight within 1 year after laparoscopic Roux-en-Y gastric bypass surgery. Further, all patients within this BMI range no longer had type 2 diabetes after the procedure.

“This initial study suggests the sooner we can treat morbid obesity and obesity-related conditions, the greater the chances the patient will have better results without any differences in complications,” John Morton, MD, associate professor of surgery and director of bariatric surgery at Stanford Hospital & Clinics at Stanford University, said in a press release. “The study raises the question as to whether early referral may lead to better outcomes.”

Between 2004 and 2010, Morton and colleagues examined 980 patients who underwent Roux-en-Y gastric bypass surgery at their institution. They then analyzed them according to BMI: less than 35 (group 1); 35 to 39.9 (group 2); 40 to 49.9 (group 3); and more than 50 (group 4).

Results showed considerable differences in weight loss between all groups. At 3 months, patients with a BMI of less than 35 lost the most excess weight (76.1%) vs. higher BMI (34%-66%). This trend also persisted at 6 months (116.7% vs. 51.7%-91.9%) and 1 year (167.1% vs. 67.1%-112%).

“There appears to be a dose-dependent effect to weight loss and preoperative weight loss — higher BMI lost proportionally less weight than the lower BMI,” Morton said in the release.

Diabetes remission was also highest among patients with a BMI of less 35, with 100% of those in this group experiencing remission after surgery, whereas patients in the higher BMI groups had lower rates of remission (72.7% to 74.6%).

“This study suggests that BMI should not be the only indicator for bariatric surgery, particularly if lower BMI patients can see these kinds of results,” Morton said. “It may be time for a re-evaluation.”

In February, the FDA approved laparoscopic adjustable gastric banding (Lap-Band, Allergan) for obese adults with a BMI of at least 30 and with at least one obesity-related condition. Previously, the device was indicated for use in patients with a BMI of at least 40 or a BMI of at least 35 with the presence of comorbidities.

For more information:

• Ahmed S. P-54. Presented at: the 28th Annual Meeting of the American Society for Metabolic and Bariatric Surgery; June 12-17, 2011; Orlando, Fla.

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