Weight Loss Surgery for Patients With A Lower Body Mass Index
The concept of preventing diseases like diabetes, obstructive sleep apnea or hypertension usually centers around behaviors such as improved eating habits and exercise, and no doubt these are highly important for preventing weight gain related conditions. Less commonly acknowledged is that people who need to lose 40 to 60 pounds can do so successfully before they have developed many of the most severe obesity related health conditions. Thus, they are able to prevent disease rather than waiting until the diseases have become fully manifest and are already requiring medical treatment just to manage them.
In numerous studies, no intervention has proven more successful than weight loss surgery for achieving this drop in pounds necessary to prevent the health conditions and diseases mentioned. The list of health conditions that are going to come along with a 50 pound weight gain is quite long and includes many problems including difficult injuries of the weight-bearing bones and joints including the spine, ankles, hips and knees, but many other conditions as well including asthma exacerbations, breathing difficulties, fatty liver infiltration (hepatic steatosis) and pre-diabetes or impaired glucose tolerance and headaches.
But weight loss surgery as a preventive treatment? Clearly, this idea is far from an accepted notion and runs counter to most people’s notion of what preventive interventions consist of. Nonetheless, the data bespeaks themselves and if you or a loved one are in the range of 40 to 50 pounds overweight and have a BMI between 30 and 35, then you have to look at what interventions are likely to be most successful at helping you live a longer and healthier life (not to mention feel better and feel more energetic). You also have to look at what you can do to prevent the onset of diabetes, which is highly likely to occur at that BMI, given enough time. Then I think it makes sense to examine the risks associated with any intervention and invasiveness.
At our center, I have taken the approach that laparoscopic adjustable gastric banding is of such low invasiveness that it does make a great deal of sense as a disease prevention tool whereas our protocol has not included laparoscopic sleeve gastrectomy or Roux-en-Y gastric bypass surgery. In the future this may change, but right now the risk/benefit analysis in my view favors making available the least invasive weight loss surgical option for this low BMI group of 30 to 35.