Are Qualifications for BMI Surgery Outdated?
The standard qualifications for being a candidate for bariatric surgery according to the National Institute of Health are as follows:
- BMI 40+ or 100 pounds overweight, or
- BMI in the range of 35-40 and at least one weight-related condition, such as high blood pressure, non-alcoholic fatty liver disease, sleep apnea, type 2 diabetes, heart disease, etc.
These qualifications were established by the National Institute of Health in 1991. Did you know that the first website was built in 1991 and put online in August of that year? The first web browser did not become available to the public until 1993. Imagine if computer technology was still stuck in 1991! With all the advancements in technology, science, and medicine, the National Institute of Health is still using these standards.
Here is an example of a BMI chart that outlines body mass index (BMI) ranges and associated categories.
Body Mass Index Chart
|Body Mass Index (BMI) Range||Person Is Considered|
|Under 15.99||Very underweight|
|16 – 16.9||Underweight|
|17 – 18.4||Slightly underweight|
|18.5 – 24.9||Healthy weight (normal)|
|25 – 29.9||Overweight|
|30 – 34.9||Obesity Class I|
|35 – 39.9||Obesity Class II (severe)|
|40 – 44.9||Obesity Class III (morbid)|
|45 – 50||Obesity Class III (super)|
Metabolic Set Point
Today doctors know many things about our bodies but when it comes to weight loss, they are still trying to figure out why some individuals seem to have a much harder time losing weight and maintaining that weight loss than others. Studies have determined that our bodies have some sort of metabolic ‘set point’ when it comes to our weight.
While there is uncertainty in how this point is triggered, it is thought it could be influenced by large weight gains and our “western” diet or a combination of these consisting of large amounts of processed foods, red meat, foods with high sugar content, high-fat dairy products, and pre-packaged foods.
When an individual starts dieting and exercising to lose weight, the body’s natural protection mode kicks in to preserve the weight reserves by increasing the appetite and slowing down the metabolism, so fat is not burned as fast.
This just causes a yo-yo effect with gaining and losing weight and starts a vicious cycle. The individual can be left feeling defeated and weak because of their lack of willpower; but it is not their willpower at all, it is their own body working against them.
Bariatric surgery can be a very effective tool for weight loss and resetting the body’s “set point”. During weight loss surgery, the way the body processes food changes, and most of the sources for hunger-producing hormones are eliminated. These changes can make our bodies stop working against us when we endeavor to lose weight.
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Low BMI Patients and Bariatric Surgery
There are a number of people who are considered obese but fall outside of the bariatric surgery qualifications. These patients fall in the BMI range of 30-39.9 and can suffer from obesity-related health issues like type 2 diabetes, high blood pressure, sleep apnea, etc.
Yet, this group of Class I obese people would have to gain more weight in order to be given an opportunity to use this proven tool of bariatric surgery to help them lose weight. It is crazy and I will give you a few reasons why.
The more weight an individual gains, the harder it is for them to lose it and maintain a healthy weight in the long run. Also, obese patients have more health problems, and one that occurs very frequently is type 2 diabetes.
Numerous studies have shown that bariatric weight loss surgery puts type 2 diabetes into remission in about 90% of cases. This means no more insulin or medicine is needed to control the blood sugar of all these patients. That adds up to a very big chunk of money saved by insurance companies and individuals for medication. It makes more sense to cure the disease by addressing the real problem than it does to treat a lifetime of symptoms.
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Endorsing Bariatric Surgery for Patients with Lower BMIs
The American Society Of Metabolic and Bariatric Surgery updated their position on qualifiers for weight loss surgery to include Class I obese patients. Since their publication, several other bariatric-specific organizations followed their steps (the International Federation for the Surgery of Obesity and Metabolic Disorders and The National Institute for Health and Care Excellence, UK).
At The Diabetes Surgery Summit (an international conference, where the leading diabetes organizations collaborated to pen global guidelines regarding bariatric and metabolic surgery to treat type 2 diabetes) the guidelines were formally endorsed by The American Diabetes Association, The International Diabetes Federation, and 45 worldwide scientific medical societies. The guidelines indicate that:
Individuals that fall into the Class I obesity category and experience inadequately controlled type 2 diabetes should be considered eligible for bariatric surgery.
Despite all the evidence indicating the benefits of including these lower BMI patients in the guidelines, the National Health Institute has yet to update their 1991 statement, which insurance companies use as their baseline.
There have been many advancements, new surgical procedures, and technological improvements in the field of bariatric surgery since these guidelines were published. These advancements, such as replacing open surgery with laparoscopic surgery, have significantly lowered the risks of bariatric procedures.
Best Bariatric Surgery Options for Low BMI Patients
The type of surgery that will work best will vary by patient and their unique circumstances. The American Society For Metabolic and Bariatric Surgery suggests gastric bypass and sleeve gastrectomy as good choices for patients with BMI between 30 and 35.
One study conducted over a 5 -year period made a good case for sleeve gastrectomy surgery in lower BMI patients reporting excellent results.
In another study, patients with type 2 diabetes, hypertension, and sleep apnea were monitored after having bariatric surgery.
Some patients with type 2 diabetes had laparoscopic gastric bypass and other patients had laparoscopic sleeve gastrectomy.
- 86% of the patients with type 2 diabetes experienced remission;
- 87% of patients with hypertension experienced remission, and
- 100% of sleep apnea patients experienced remission.
The study concludes: “The results of our study support the validity of bariatric surgery in patients with BMI 30-35”.
Non-Invasive Bariatric Procedures for Lower BMI Patients
Research has shown that early intervention directly relates to the longevity of the results when it comes to weight loss surgery, especially in patients with type 2 diabetes. The patients who had been experiencing type 2 diabetes for at least 5 years before bariatric surgery were more likely to not find relief after surgery or temporarily go into remission but flare up again in a few years.
This indicates that patients would benefit from weight loss procedures before health-related issues take root. Both gastric balloons and endoscopic sleeve gastroplasty may also be good options for patients in the BMI range of 30-34.9.
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There are a few different types of gastric balloons, some are singular and in some cases, they use more than one balloon. Each system works by taking up space in the stomach, so the patient feels full from a smaller amount of food.
This helps patients reduce portion sizes and eat less. The balloon is temporary and is removed from the stomach after 6 months. While the balloon is in the stomach and for 6 months after it is removed, patients are supported through ongoing nutritional and behavioral sessions. At the IBI Healthcare Institute, we offer the Orbera Balloon System.
Endoscopic Sleeve Gastroplasty (ESG)
Endoscopic sleeve gastroplasty is a non-surgical procedure where the stomach size is reduced through the use of sutures. Using an endoscope, the stomach is accessed and about 75% of the stomach is blocked off making it substantially smaller.
The smaller stomach helps patients to not overeat at mealtime and food takes a bit longer to digest, which helps them feel full for longer periods of time. The procedure only takes about 45 minutes, it does not require any incisions, there is no hospital stay involved, and the recovery is much shorter than surgery.
Here, at the IBI Healthcare Institute, we evaluate patients individually and are committed to helping everyone we can help. If you or a loved one falls into the BMI range of 30-34.9, and you are interested in bariatric surgery or a non-surgical weight loss procedure to help you regain health, contact IBI Healthcare Institute today. Our team of experts can help you learn about procedures that will work for you and give you all the information necessary to make an informed decision.