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Surgical Options for BMI 30 - 35 We are pleased to announce open enrollment in two separate Institutional Review Board (IRB)-approved studies to treat Class I obesity (BMI 30 – 35 kg/m2) using either laparoscopic adjustable gastric band (LAGB) placement or; in the presence of Type 2 Diabetes Mellitus, laparoscopic sleeve gastrectomy (LSG). Outside of such a study, bariatric surgery is only approved to patients who meet the 1991 NIH Consensus Panel guidelines in which you must have a BMI of at least 40 in the absence of any significant obesity-related medical diseases; or 35 with such a disease; and be an acceptable surgical candidate. In spite of these guidelines, obesity (BMI > 30) afflicts 30% of our population as do many of the myriad of obesity-related diseases.
With respect to the LAGB study, in other countries (where the U.S. federal guidelines do not apply), excellent results have been achieved with offering the LAGB to patients with BMI > 30. An Australian study of 80 patients with BMI 30 – 35 randomized to intensive medical weight loss versus LAGB achieved an 87% of excess weight lost (excess weight is the difference between your actual weight and your ideal body weight) with LAGB vs 5.5% with medical weight loss at 2 years. The also demonstrated significant improvement in medical conditions including the metabolic syndrome in the surgical group.
Our hypothesis is that U.S. patients with BMI 30-35 would also benefit substantially from such a procedure. We are enrolling patients to be part of the study and undergo a thorough evaluation and participate in an intensive educational program to achieve the best results from a comprehensive program including LAGB. As this procedure is being offered outside of the NIH criteria, insurance companies will unlikely cover the cost of the surgery however we have negotiated competitive pricing with our affiliated hospitals and anesthesia departments. In addition, financing options are available. For interested candidates, please contact our office.
With respect to the LSG-diabetes trial, other studies have demonstrated 65-85% long-term remission rates (overall rate of 70%) of diabetes following LSG in patients with BMI > 35. The American Diabetes Association 2009 guidelines now recommend bariatric surgery for type 2 diabetics with BMI of at least 35. For patients with BMI 30-35, there is insufficient data at this time and therefore such patients may be offered surgery in the context of a study. Ours is such a study.
Since 23.7 million Americans suffer from diabetes of whom 90% have type 2 diabetes and of whom 90% are obese (BMI of at least 30), there is a great need for such treatment. We anticipate that 70% may achieve long-term remission from surgery. Patients with type 2 diabetes and a BMI of at least 30 may contact our center to determine whether or not they are a candidate for this study.
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