Patients with Class I Obesity Still Benefit from Weight-Loss Surgery

People with class I obesity, who are generally not eligible for bariatric surgery, saw gains from weight-loss surgery, a researcher reported.

Patients with BMI 30-35 lost up to 20% of their initial BMI, and were 45% more likely to be in remission from type 2 diabetes, 2 years after either gastric bypass or sleeve gastrectomy, according to Maria Altieri, MD, of East Carolina University Brody School of Medicine in Greenville, North Carolina.

There were some differences for patients based on the type of surgery they received, Altieri noted in a presentation at the American Society for Metabolic & Bariatric Surgery (ASMBS) virtual meeting.

Patients who had gastric bypass were about twice as likely to be in remission from hyperlipidemia versus those who underwent sleeve gastrectomy. Also, about 50% of the patients who had gastric bypass were in diabetes remission after 2 years versus 25% of those who got sleeve gastrectomy. The likelihood of remission of high blood pressure after 3 years was 60% for gastric bypass and 50% for sleeve gastrectomy.

However, there “was no difference between the BMI trajectories and remission from [type 2 diabetes] when comparing the two groups,” the authors stated.

“This study confirms the effectiveness of bariatric surgery in patients with class 1 obesity in real-world settings and suggests earlier intervention in patients with less severe disease should be considered,” Altieri said. “This data further supports the need to update the current indication criteria.”

The NIH established indications for bariatric surgery 30 years ago and, under those guidelines, patients with a BMI of ≥35, along with an obesity-related disease such as diabetes, are eligible candidates, according to the authors.

For the retrospective study, Altieri and colleagues evaluated patients from a clinic system’s electronic health record (EHR) database, and identified 566 adults who underwent Roux-en-Y gastric bypass and 730 patients who underwent sleeve gastrectomy. The researchers then followed the patients through their EHRs to determine outcomes. They reported that being of younger age, female, and having an obesity-related comorbidity were associated with greater weight loss.

ASMBS president Matthew Hutter, MD, of Harvard Medical School in Boston, noted in a statement that “The evidence continues to mount that people with lower BMIs can benefit from metabolic and bariatric surgery. This warrants a reevaluation of patient selection criteria so that all those who can benefit have access to this lifesaving treatment.”

In a 2018 position statement, ASMBS recommended that individuals with class I obesity be offered bariatric surgery as an option after failure of nonsurgical treatments, as the latter “are often ineffective at achieving major, long-term weight reduction and resolution of co-morbidities.” Earlier, the American Diabetes Association and others issued a joint statement that weight-loss surgery should be considered for patients with type 2 diabetes and a BMI 30.0-34.9 if hyperglycemia is inadequately controlled despite optimal treatment with either oral or injectable medications.

According to ASMBS data, an estimated 256,000 bariatric surgeries were performed in 2019, representing <1% of the currently eligible surgical population by BMI.