Bariatric Surgery for Diabetic Patients with a BMI Under 35

In 1991, the National Institutes of Health (NIH) released criteria that patients must meet in order to have bariatric surgery.  For over 20 years, surgeons have used those criteria to select appropriate candidates for weight loss surgery.  With improvements in techniques and procedures over the years, researchers have been questioning whether the NIH guidelines should be broadened to allow more people to take advantage of the benefits of weight loss surgery.  This is especially true for people with type 2 diabetes who have a body mass index (BMI) less than 35.  Under current guidelines, such people do not qualify for bariatric surgery.

An article in this month’s “Journal of the American College of Surgeons,” examines this issue closely.  The authors conducted a meta-analysis (or review) of 39 different studies that included 1,389 diabetic patients with BMI’s under 35.  The average BMI in the study was 30.5.  Each of these patients underwent weight loss surgery to see how their diabetes would be affected.  Remission rates of diabetes are shown in the table below:

Remission rate at 12 months
gastric banding 32.7%
sleeve gastrectomy 53.9%
gastric bypass 63.6%


Bariatric surgery clearly benefited diabetic patients in these lower weight ranges.  Keep in mind, this data represents people who went into complete remission of their diabetes, meaning they had a normal hemoglobin A1c of <6.5 while coming off of all their diabetic medication.  Even though everyone did not go into complete remission, 95% of patients still saw improvement in their sugars after bariatric surgery.

Studies like these make a compelling case to broaden the criteria for bariatric surgery to help more people who suffer from diabetes.

Carl Lowe, Jr., MD


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