Gastric Sleeve Surgery for Patients with Low Initial BMI (BMI 30-35)
I recently wrote a post entitled “Weight Loss Surgery for Low BMI Patients (BMI 30-35).” In this post I reviewed the guidelines published by the ASMBS for weight loss surgery for low BMI patients, and I reviewed some recent published studies on weight loss surgery for low BMI patients.
In this post I want to specifically discuss the gastric sleeve operation for low BMI patients, and review our gastric sleeve patient outcomes for low BMI patients in Orange County, California.
First, let’s review the low BMI position statement published by the American Society for Metabolic and Bariatric Surgery (ASMBS) in 2012. The purpose of this position statement was to provide guidelines for the use of bariatric surgery in low BMI patients (BMI 30-35). BMI (body mass index) of 30-35 corresponds to approximately 50-75 pounds over ideal weight.
The summary and recommendations from the ASMBS position statement on bariatric surgery in class 1 obesity are as follows:
- Class I obesity (BMI 30-35) is a well-defined disease that causes or exacerbates multiple other diseases, decreases the duration of life, and decreases the quality of life. The patient with Class I obesity should be recognized as deserving treatment for this disease.
- Current options of non-surgical treatment for Class I obesity are not generally effective in achieving a substantial and durable weight reduction.
- For patients with BMI 30-35 who do not achieve substantial and durable weight and comorbidity improvement with non-surgical methods, bariatric surgery should be an available option for suitable individuals. The existing cut-off of BMI which excludes those with Class 1 obesity was established arbitrarily nearly 20 years ago. There is no current justification on grounds of evidence of clinical effectiveness, cost-effectiveness, ethics or equity that this group should be excluded from life-saving treatment.
- Gastric banding, sleeve gastrectomy, and gastric bypass have been shown in randomized, controlled trials to be safe and effective treatment for patients with BMI 30-35 in the short and medium term.
Since the ASMBS position statement on the use of bariatric surgery in low BMI patients was published in 2012, several things have happened: the LAP-BAND® operation has been largely abandoned, the gastric sleeve operation has grown in popularity to dominate the field of weight loss surgery, and several studies have been published specifically on the use of the gastric sleeve operation in low BMI patients.
The Gastric Sleeve Operation Is the Most Popular Weight Loss Operation
The gastric sleeve operation became the most commonly performed weight loss operation in the United States in 2013, and since then it has continued to grow in popularity.
In 2017, >70% of all first time weight loss operations performed in the United States were gastric sleeve operations. The gastric bypass operation is the second most popular weight loss operation, accounting for approximately 22% of all first time weight loss operations performed in 2017.
Read my recent post entitled “Sleeve Gastrectomy Dominates the Field of Weight Loss Surgery.”
Low risk is the #1 reason for the impressive popularity of the gastric sleeve operation. The gastric sleeve operation is less invasive, and therefore lower risk, than the current alternative operations – gastric bypass and duodenal switch. This makes the gastric sleeve operation potentially an ideal choice for low BMI patients.
Gastric Sleeve Surgery for Low BMI Patients – Published Literature
Several studies have been published on gastric sleeve surgery in low BMI patients, as I summarized in the post Weight Loss Surgery for Low BMI Patients (BMI 30-35). These published studies all show the gastric sleeve operation to be safe and effective for low BMI patients.
The best published study to date on sleeve gastrectomy for low BMI patients is a study published in 2016 entitled “Results of Laparoscopic Sleeve Gastrectomy in 541 Consecutive Patients with Low Baseline Body Mass Index (30-35kg/m^2).”
In this study, the authors evaluated 541 patients with low BMI who underwent sleeve gastrectomy surgery between 2010 and 2015. They reported excellent outcomes: weight loss averaged 78% of excess weight at 1 year after surgery, leak rate was 0%, and bleeding occurred in 1.2%.*
Several other smaller studies have been published that have also shown good outcomes in low BMI patients:
Bariatric Surgery in Moderately Obese Patients
Sleeve Gastrectomy for Patients with Class 1 Obesity (BMI 30-35)
Diabetes in Patients with BMI 30-35: Sleeve Gastrectomy vs. Medical Treatment
Our Gastric Sleeve Outcomes in Low BMI Patients (BMI 30-35)
We have been performing weight loss surgery for low BMI patients in Orange County since 2003. We have operated on 260 low BMI patients – 19 gastric bypass, 166 gastric banding (none since 2013), and 75 sleeve gastrectomy. Currently we mostly do sleeve gastrectomy for low BMI patients, but we also occasionally do gastric bypass for low BMI patients with diabetes and for low BMI revision patients.
Our experience with sleeve gastrectomy for low BMI patients in Orange County is similar to the experience reported in the first study discussed above – Results of Laparoscopic Sleeve Gastrectomy in 541 Consecutive Patients with Low Baseline Body Mass Index (30-35kg/m^2).
Our low BMI gastric sleeve patient population is as follows: total number of patients to date 75, 89% women, 11% men, average starting weight for women 197 pounds, average starting weight for men 247 pounds.
Our gastric sleeve outcomes in low initial BMI patients have been excellent. Our BMI 30-35 patients average 87% EWL (excess weight loss) at 1 year postop, 82% EWL at 2 years postop, and 78% EWL at 3 years postop.*
Our BMI 30-35 female patients average starting weight is 197 pounds, and their average weight at 1 year after surgery is 142 pounds.*
Our gastric sleeve complication rates in low initial BMI patients are low. Our gastric sleeve leak rate is 0%, our gastric sleeve bleeding rate is 0%, our 30 day readmission rate is 0%, and our 30 day reoperation rate is 0%.* We had 3 late reoperations, 1 for gallbladder removal due to gallstones, and 2 for hiatal hernia repair.*
The gastric sleeve operation may be a reasonable option for patients with lower starting body mass index (BMI 30-35, generally 50-75 pounds over ideal weight) who have been unable to lose weight and maintain weight loss using nonoperative methods.
Published studies, and our patient data, show excellent weight loss results and low complication rates in the BMI 30-35 population over the short and medium term, and therefore support the use of sleeve gastrectomy in this group of patients.
* Patient outcomes vary after weight loss surgery. Past outcomes may not be indicative of future results.