THURSDAY, June 16 (HealthDay News) -- Obese patients whose
body-mass index (BMI) falls below the minimum level recommended for
weight-loss surgery may have better outcomes than those who are
more obese, new research suggests.
An analysis of data from nearly 1,000 patients revealed that
those patients whose pre-surgery BMIs were
below the federal guideline threshold of 35-plus experienced
a 100 percent remission from type 2 diabetes in the year following
In contrast, the remission rate for type 2 diabetes in obese
patients with a BMI of 35 or more was about 75 percent.
"There was a clear trend that as your weight was lower when having gastric bypass surgery, your outcomes were actually better," noted study co-author Dr. John Morton, director of bariatric surgery at Stanford Hospital & Clinics at Stanford University in Palo Alto.
"This finding suggests that perhaps we should be getting patients to surgery sooner than later, before their weight goes too high and the surgery comes less effective," Morton said.
"After all, when we talk about patients below a BMI of 35, we're not talking about people who are just pleasantly plump," Morton added. "These are people with real, substantial risks associated with excess weight, particularly with respect to diabetes, which has a lot of negative consequences."
Morton and his colleagues are slated to present their findings
Thursday at the American Society for Metabolic & Bariatric
Surgery annual meeting, in Orlando, Fla. Because the study has not
been published in a peer-reviewed journal, its findings should be
viewed as preliminary.
Guidelines from the National Institutes of Health recommend
gastric bypass only for patients whose BMI is 35 or more and who
have an obesity-related condition (such as high blood pressure,
sleep apnea, joint disease and/or metabolic syndrome) and who have
not been able to lose weight through less invasive methods.
For someone with a BMI of 40 or more, an obesity-related disease
is not necessary to qualify for weight-loss surgery, according to
Morton noted that ideally one's BMI should clock in under 25.
For a woman with a height of 5-foot-4, this would roughly equate to
weighing about 140 pounds.
A woman of the same height who weighs 200 pounds would actually
fall just short of the BMI threshold of 35, he said, while at 300
pounds the same woman would have a BMI of nearly 52.
Morton explained that the current study came about almost
accidentally, as a result of a Stanford pre-surgical program
designed to educate prospective patients about the surgery and to
encourage them to adopt better nutritional habits before the
Out of the 980 obese patients who had met the NIH criteria when
they were initially slated for surgery between 2004 and 2010, 12
patients actually showed up for the procedure at BMI levels below
the recommended cut-off point for surgery.
The result: a year following surgery, those patients with a BMI
under 35 not only experienced better outcomes in terms of diabetes,
but lost more weight than those who met the recommended BMI
threshold for weight-loss surgery. They also showed more
improvement in obesity-related conditions in addition to
At check-ins from three-months to a year after surgery, the
patients who weighed less than that recommended for gastric bypass
had also lost more weight than those with the higher BMIs. At the
12-month mark, they had lost 167 percent of their excess weight, in
contrast to those with a BMI of 35 to 40 (112 percent), 40 to 45
(85.3 percent), and 50 (67 percent).
The authors also noted that the time it took to perform the
gastric bypass procedure itself was also shorter for those with
"What we found amounts to what I think is a big lesson: we ought to intervene with these patients earlier than previously thought," said Morton.
Like all operations, weight-loss surgery is not without risk.
Complications include serious infections, internal bleeding and
blood clots, and the risk of dying is one in 1,000, according to
the American Society for Metabolic & Bariatric Surgery.
Weight-loss surgeries are also expensive, costing about $20,000
to $25,000 or more, depending on the procedure.
Dr. David M. Kendall, chief scientific and medical officer of
the American Diabetes Association, approached the findings with
"While these are exciting and interesting findings, it is really the first set of evidence that looks at this specifically," he said. "We need more research with larger groups and for longer periods of follow-up before we can really start ringing the bell."
"More generally, the other thing I would add is that while bariatric surgery has on several occasions shown impressive results across various bands of weight, people need to be reminded that even modest weight loss and improved glucose control in the absence of surgery can help immensely in terms of
diabetes control" and prevention, Kendall said.
For more on bariatric surgery, visit the
National Institutes of Health.
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