New Study Suggests: Don’t Wait to Have Bariatric Surgery Patients with BMI Below 40 Did Better
Than Those with Severe Obesity


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Published in September Issue             

A new study published online in the July issue of JAMA Surgery suggests bariatric surgery may yield better results for patients whose body mass index (BMI) has not yet reached 40.

According to researchers from the University of Michigan, Wayne State University and Henry Ford Health System, 36 percent of bariatric surgery patients, with an average BMI of 48, were able to achieve a BMI of less than 30. Only 8.5 percent of patients with of BMI of 50 or higher were able to match those results.

Researchers reviewed the medical records of 27,320 adults undergoing bariatric surgery between June 2006 and May 2015 at teaching and nonteaching hospitals in Michigan.
On average, patients had a BMI of 48 before their operation, and got down to 33 by the end of the first year. The study was funded by Blue Cross Blue Shield of Michigan.

Those who achieved a BMI less than 30 were also more likely to report they were able to stop taking medications for hyperlipidemia (60.7% vs 43.2%), diabetes (insulin: 67.7%
vs 50.0%) ; oral medications: (78.5% vs 64.3%), and hypertension (54.7% vs 34.6%). Sleep apnea remission was also significantly higher (72.5% vs 49.3%), as was patient satisfaction with the surgery (92.8% vs 78.0%).

“Bariatric surgery is extremely safe and effective and should be considered as first-line therapy for patients with a BMI between 35 and 40,” said lead author Oliver Varban, MD, director of bariatric surgery at Michigan Medicine, University of Michigan’s medical center, in a news release. “Waiting for a patient to reach a BMI over 50 only serves to limit the benefits of bariatric surgery as an intervention.”

The study authors concluded that policies and practice patterns that delay bariatric surgery until the BMI is 50 or greater can result in significantly inferior outcomes.

American Society of Metabolic and Bariatric Surgery (ASMBS) president Stacy Brethauer, MD, who was not involved in the study,
told Medscape, the study findings make sense in that “we're treating a chronic disease, and the earlier you intervene in any chronic disease, the better your outcomes are going to be." However, he said, the findings “shouldn’t be used as a way to discourage someone with a BMI of 50 to undergo bariatric surgery, because they’ll still derive benefit.”

In addition to having a lower BMI, the type of procedure a patient had was a significant predictor of success. The majority patients who achieved a BMI below 30 received gastric bypass (56.8%), followed by sleeve gastrectomy (36%), gastric banding (5.5%) and duodenal switch (1.8%).

The authors say the results of their study have implications for patient referrals and how insurers cover weight-loss surgery, including requirements that patients fail to achieve a specific BMI under medically supervised non-surgical options before plans will approve coverage for surgery. The authors hope their new results will inform these
coverage requirements.

“Despite its proven safety and efficacy, bariatric surgery remains highly regulated and can be misunderstood by referring physicians and patients alike,” says Dr. Varban. “This study provides additional data to help counsel patients appropriately about weight-loss expectations after bariatric surgery.”

Having a BMI of 30 or more has been linked to diseases including type 2 diabetes, heart disease, stroke, osteoarthritis and cancer and a 50-100% increased risk of premature death compared to individuals with a healthy weight. According to the Centers for Disease Control and Prevention (CDC), more than one-third (36.5%) of U.S. adults have obesity. The ASMBS estimates that between 1% and 2% of the surgically eligible population has bariatric surgery.