Highlights
- •This study includes 1,296 patients across many institutions in the US with class I obesity.
- •Patients lost up to 20% of their initial BMI.
- •At around two years after the surgery, the likelihood of being in remission from type 2 diabetes reached 45%.
- •Remission probabilities for hypertension are 60% for RYGB and 50% for SG, three years after the surgery; hyperlipidemia are close to 50% and 25% for RYGB and SG at two years.
- •There was no difference between the BMI trajectories and remission from T2D when comparing the two groups.
Abstract
Background
NIH-established indications for bariatric surgery were set close to 3 decades ago.
Objectives
The purpose of this study was to evaluate outcomes in patients undergoing bariatric
surgery with class I obesity, a class that does not fall into current indications.
Setting
University Hospital.
Methods
De-identified records from a clinic system’s Electronic Health Record database were
accessed to identify adult patients undergoing Roux-en-Y gastric bypass (RYGB) (n
= 566) and sleeve gastrectomy (SG) (n = 730). Patients were compared in terms of resolution
of co-morbidities and weight loss outcomes at 3 years following surgery. A mixed effects
model was used, adjusting for the type of surgery, the number of quarters after the
surgery when the averaged measurements were taken, and the interaction between these
two variables.
Results
Patients lost up to 20% of their initial body mass index (BMI). Being of younger age,
female, and having an obesity-related co-morbidity were associated with greater weight
loss. At around 2 years after the surgery, the likelihood of being in remission from
type 2 diabetes reached 45%. Remission probabilities for hypertension are 60% for
RYGB and 50% for SG, 3 years after the surgery. On the other hand, the probabilities
of remission from hyperlipidemia are close to 50% and 25% for RYGB and SG at 2 years.
There was no difference between the BMI trajectories and remission from type 2 diabetes
(T2D) when comparing the 2 groups.
Conclusions
Bariatric surgery is effective in weight loss and resolution of comorbidities in patients
with class I obesity. This data further supports the need to revisit the current indication
criteria.
Key words
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Surgery for Obesity and Related DiseasesAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Trends in obesityamong adults in the United States, 2005 to 2014.JAMA. 2016; 315: 2284-2291
- The effect of body mass index on perioperative outcomes after major surgery: results from the National Surgical Quality Improvement Program (ACS-NSQIP) 2005–2011.World J Surg. 2015; 39: 2376-2385
- Length of hospital stays among obese individuals.Am J Public Health. 2004; 94: 1587-1591
- Economic burden of obesity: a systematic literature review.Int J Environ Res Public Health. 2017; 14: 435
- Surgery for weight loss in adults.Cochrane Database Syst Rev. 2014; 8: CD003641
- Weight loss and health status 3 years after bariatric surgery in adolescents.N Engl J Med. 2016; 374: 113-123
- Seven-year weight trajectories and health outcomes in the Longitudinal Assessment of Bariatric Surgery (LABS) study.JAMA Surg. 2018; 153: 427-434
- Insurance coverage criteria for bariatric surgery: a survey of policies.Obes Surg. 2020; 30: 707-713
- Summary: consensus conference on surgery for severe obesity.Surg Obes Relat Dis. 2005; 1: 369-370
- Measuring frailty in medicare data: development and validation of a claims-based frailty index.J Gerontol A Biol Sci Med Sci. 2018; 73: 980-987
- American Diabetes Association [homepage on the Internet]. Arlington, VA: The Association; c1995–2022 [cited 2021 May 2]. Understanding A1C: diagnosis; [about 7 screens].(Available from:)
- Prevention, detection, evaluation, and management of high blood pressure in adults: synopsis of the 2017 American College of Cardiology/American Heart Association Hypertension guideline.Ann Int Med. 2018; 168: 351-358
- Standardized outcomes reporting in metabolic and bariatric surgery.Obes Surg. 2015; 25: 587-606
- The incidence of co-morbidities related to obesity and overweight: a systematic review and meta-analysis.BMC Public Health. 2009; 9: 88
- ASMBS updated position statement on bariatric surgery in class I obesity (BMI 30–35 kg/m2).Surg Obes Relat Dis. 2018; 14: 1071-1087
- A nationwide safety analysis of bariatric surgery in nonseverely obese patients with type 2 diabetes.Surg Obes Relat Dis. 2016; 12: 1163-1170
- A current profile and assessment of north american cholecystectomy: results from the american college of surgeons national surgical quality improvement program.J Am Coll Surg. 2010; 211: 176-186
- Bariatric/metabolic surgery to treat type 2 diabetes in patients with a BMI <35 kg/m2.Diabetes Care. 2016; 39: 924-933
- Roux-en-Y gastric bypass in type 2 diabetes patients with mild obesity: a systematic review and meta-analysis.Obes Surg. 2017; 27: 2733-2739
- Role of bariatric surgery as treatment for type 2 diabetes in patients who do not meet current NIH criteria: a systematic review and meta-analysis.J Am Coll Surg. 2013; 217: 527-532
- Bariatric surgery in 1119 patients with preoperative body mass index <35 (kg/m(2)): results at 1 year.Surg Obes Relat Dis. 2015; 11: 1127-1132
- A prospective single-arm trial of modified long biliopancreatic and short alimentary limbs Roux-En-Y gastric bypass in type 2 diabetes patients with mild obesity.Obes Surg. 2018; 28: 599-605
- Laparoscopic sleeve gastrectomy versus singe anastomosis (mini-) gastric bypass for the treatment of type 2 diabetes mellitus: 5 year results of a randomized trial and study of incretin effects.Obes Surg. 2014; 24: 1552-1562
- Effects of bariatric surgery vs medical treatment on type 2 diabetes in patients with body mass index lower than 35: five-year outcomes.JAMA Surg. 2015; 150: 1117-1124
- Seven years of mini-gastric bypass in type II diabetes patients with a body mass index <35 kg/m2.Obes Surg. 2016; 26: 1457-1462
Article info
Publication history
Published online: January 24, 2022
Accepted:
January 12,
2022
Received:
August 12,
2021
Footnotes
The study was funded by OptumLabs, the research and development arm of UnitedHealth Group.
Identification
Copyright
© 2022 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.
ScienceDirect
Access this article on ScienceDirectLinked Article
- Comment on: Real-world retrospective analysis of outcomes in patients undergoing bariatric surgery with class 1 obesitySurgery for Obesity and Related DiseasesVol. 18Issue 5
- PreviewThe rationale that bariatric surgery should be performed in patients with body mass index (BMI) ≥35 kg/m2 is getting weaker [1]. For bariatric surgery, evidence of durable weight loss and effective co-morbidity resolution in class I obesity has been accumulated, and some countries, including Korea, are implementing insurance benefits for class I obesity with co-morbidities. Altieri et al. (2021) [2] conducted a significantly meaningful study that presented additional evidence of the usefulness of bariatric surgery in cases of class I obesity.
- Full-Text
- Preview
