Abstract
Purpose Patients with mild obesity especially in absence of associated medical problems (OAMP) are commonly managed by non-surgical approaches. Laparoscopic sleeve gastrectomy (LSG) has proved itself to be effective and it is now the most performed weight loss procedure. We aimed to study the effectiveness and safety of LSG for weight loss in mild obesity.MethodsA prospective cohort study. Group A; BMI (30–34.9 kg/m2), and group B; BMI ≥ 40 or BMI ≥ 35 with OAMP. Demographic data, perioperative complications, % excess weight loss (EWL), % total weight loss (TWL), nutritional profile, and evolution of OAMP were recorded and statistically analyzed.ResultsA total of 250 patients, with 80 patients (32%) in group A, and 170 (68%) in group B. The majority were female. The mean preoperative weight, BMI, and excess weight were 90.1 ± 9.52, 32.7 ± 1.4, and 21.5 ± 4.9 in group A, and 129.88 ± 26.12, 47.8 ± 8.2, and 62.3 ± 23.6 kg in group B respectively. The low BMI group had significantly lower OAMP, with higher pre-LSG non-surgical procedures rate. Overall post-operative morbidity rate was significantly higher in group B. %TWL was significantly lower in low BMI group. Nutritional profile was within the normal range in both groups at 3-year follow-up.ConclusionLaparoscopic sleeve gastrectomy is a safe and effective weight loss solution for mild obesity with better outcome than for higher BMI. Further studies are warranted to reconsider NIH’s statement for medicolegal aspects, and for matching the current changes in bariatric surgery practice, safety evidence, and patients’ demand.Graphical abstract
Highlights
The current international medicolegal body mass index (BMI) cut-off for bariatric surgery in many countries is based on the National Institutes of Health (NIH) statement in 1991, with severe
The safety and effectiveness of the metabolic effect of bariatric and metabolic surgery (BMS) in patients with mild obesity have been thoroughly investigated in the literature especially in patients with T2DM and in Asian populations due to ethnic liability for OAMP
We believe that the main reason for not lowering the cut-off for surgery was the economic and national regularity conditions rather than the safety of the procedure, as already the action BMI cut points are reduced by 2.5 kg/ m2 to BMI 27.5, 32.5, and 37.5 kg/m2 for Asian populations due to ethnic liability for obesity-associated medical problems [15]
Summary
The current international medicolegal BMI cut-off for bariatric surgery in many countries is based on the National Institutes of Health (NIH) statement in 1991, with severe. The safety and effectiveness of the metabolic effect of bariatric and metabolic surgery (BMS) in patients with mild obesity have been thoroughly investigated in the literature especially in patients with T2DM and in Asian populations due to ethnic liability for OAMP. This has led different international and national BMS societies to recommend surgery in patients with class 1 obesity who do not achieve substantial and durable weight and OAMP improvement with nonsurgical methods [2,3,4,5,6,7,8,9]. We aimed in our study to evaluate the effectiveness and safety of LSG as a weight loss solution for patients with class 1 obesity
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