Study supports expanding the candidate pool for bariatric surgery

Last Updated: 2015-11-05

By Megan Brooks

NEW YORK (Reuters Health) - Bariatric surgery is a relatively safe option for managing uncontrolled type 2 diabetes in overweight or mildly obese adults, according to a new study from the Cleveland Clinic in Ohio.

Current guidelines from the National Institutes of Health (NIH) put forth in 1991 consider bariatric surgery an option only for morbidly obese people with a body mass index (BMI) of 35 kg/m2 or higher with one or more obesity-related conditions such as diabetes.

But over the last 20-25 years, the field of bariatric surgery has "significantly evolved" with introduction of newer less-invasive approaches, making it safer, Dr. Ali Aminian, laparoscopic and bariatric surgeon at the Cleveland Clinic Digestive Disease Institute, noted in an interview with Reuters Health. However, until now, "the safety profile of surgery in this population of mildly obese has not been well characterized."

Using the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database, he and his colleagues analyzed 1,003 patients who underwent primary bariatric procedures in North America between 2005 and 2013.

At surgery, their BMI was between 25-35 kg/m2. The average BMI was 33.5 kg/m2 and 46 patients had a BMI of 30 or less. Forty percent of patients were on insulin and 60% were on oral diabetes medications. Roughly 78% had hypertension. Roux-en-Y gastric bypass was performed in 57% of patients, adjustable gastric banding in 23%, sleeve gastrectomy in 19%, and duodenal switch in 1%.

"The incidence of all major complications was less than 0.5% except post-op bleeding, which was 1.6%," Dr. Aminian told Reuters Health. The composite adverse event rate, which included 16 major adverse events, was 4.2%. The 30-day postoperative mortality rate was "low" at 0.2%. The procedures generally lasted about two hours, with patients leaving the hospital within two days.

Dr. Aminian reported the findings November 5 at Obesity Week 2015, hosted by the American Society for Metabolic and Bariatric Surgery (ASMBS) and the Obesity Society.

While this study focused on safety in the non-morbidly obese population, previous studies have shown that metabolic and bariatric surgery improves type 2 diabetes in nearly 90% of patients, with remission seen in up to 50% of patients.

"Bariatric surgery is emerging as a safe and effective option for managing type 2 diabetes in patients with mild obesity," Dr. Aminian said in a conference statement. "We are seeing significant improvement or remission of type 2 diabetes in most lower BMI patients. Current evidence suggests that baseline BMI is unrelated to diabetes remission following bariatric and metabolic surgery."

"I think the tide is turning," Dr. John M. Morton, president of the ASMBS and head of Bariatric and Minimally Invasive Surgery at Stanford University School of Medicine in California, who was not involved in the study, told Reuters Health. "This study addresses what I would call early-stage disease and if obesity is a disease like any other, then what that means is if you get to it sooner as opposed to later, you have a better outcome."

"A two-hour operation and a two-day hospital stay has the potential to resolve or improve what is a chronic, progressive and dangerous disease," he added in a conference statement. "The risk-benefit profile that has emerged for bariatric surgery in people with type 2 diabetes and low BMIs is very favorable and should be considered as a treatment option in carefully selected patients."