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Re-examining the BMI Threshold for Bariatric Surgery in the USA

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

The optimal BMI threshold above which gastric bypass surgery should be offered to obese patients is controversial. The objective of this study was to compare the impact of Roux-en-Y gastric bypass (RYGB) vs. diet and exercise (D&E) on life expectancy to find the BMI at which patients experience an improvement in their life expectancy by undergoing surgery.

Methods

A Markov state transition model was designed to implement a decision tree that simulated the lives of obese patients. Life expectancies following RYGB and 2 years of D&E were estimated and compared. Ten thousand patients’ lives were simulated in each weight-loss intervention group in the model. In addition to base case analysis (45 kg/m2 BMI pre-intervention), sensitivity analysis of initial BMI at the start of the study was completed. Markov model parameters were extracted from the literature.

Results

The impact of RYGB on survival relative to D&E depended on the patient’s initial BMI. Compared to patients who underwent 2 years of “optimal” diet and exercise (7 % total body weight loss/year), RYGB improved long-term survival for patients above a BMI of 31.3 kg/m2.

Conclusions

Roux-en-Y gastric bypass can improve long-term survival for patients with class I obesity. This study suggests that RYGB should not be reserved solely for patients with class II or III obesity.

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References

  1. Flegal KM, Carroll MD, Kit BK, Ogden CL. Prevalence of obesity and trends in the distribution of body mass index among us adults, 1999–2010. JAMA. 2012;307(5):491–497.

    Article  PubMed  Google Scholar 

  2. Guh D, Zhang W, Bansback N, Amarsi Z, Birmingham CL, Anis A. The incidence of co-morbidities related to obesity and overweight: A systematic review and meta-analysis. BMC Public Health. 2009;9(1):88.

    Article  PubMed Central  PubMed  Google Scholar 

  3. Field AE, Coakley EH, Must A, et al. IMpact of overweight on the risk of developing common chronic diseases during a 10-year period. Archives of Internal Medicine. 2001;161(13):1581–1586.

    Article  CAS  PubMed  Google Scholar 

  4. Berrington de Gonzalez A, Hartge P, Cerhan JR, et al. Body-mass index and mortality among 1.46 million white adults. N Engl J Med. 2010;363(23):2211–2219.

    Article  CAS  PubMed  Google Scholar 

  5. Curioni CC, Lourenço PM. Long-term weight loss after diet and exercise: A systematic review. Int J Obes Relat Metab Disord. 2005;29(10):1168–1174.

    Article  CAS  Google Scholar 

  6. Schauer PR, Kashyap SR, Wolski K, Brethauer SA, Kirwan JP, Pothier CE, Thomas S, Abood B, Nissen SE, Bhatt DL. Bariatric Surgery versus Intensive Medical Therapy in Obese Patients with Diabetes. N Engl J Med. 2012; 366:1567–1576

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  7. Podnos YD, Jimenez JC, Wilson SE, Stevens CM, Nguyen NT. Complications After Laparoscopic Gastric Bypass: A Review of 3464 Cases. Arch Surg. 2003;138(9):957–961

    Article  PubMed  Google Scholar 

  8. Gastrointestinal surgery for severe obesity: Proceedings of a National Institutes of Health Consensus Development Conference. Am J Clin Nutr. 1992;55:(2 suppl) 487S–619S

  9. Voigt K, Schmidt H. Gastric Banding: Ethical Dilemmas in Reviewing Body Mass Index Thresholds. Mayo Clin Proc. 2011;86(10):999–1001.

    Article  PubMed Central  PubMed  Google Scholar 

  10. The Clinical Issues Committee. ASMBS Position Statement: Bariatric Surgery in Class 1 Obesity (BMI 30–35 kg/m2). 2012.

  11. O’Brien PE, Dixon JB, Laurie C, et al. Treatment of mild to moderate obesity with laparoscopic adjustable gastric banding or an intensive medical Program A randomized trial. Annals of Internal Medicine. 2006;144(9):625–633.

    Article  PubMed  Google Scholar 

  12. Maggard-Gibbons M, Maglione M, Livhits M, et al. Bariatric surgery for weight loss and glycemic control in nonmorbidly obese adults with diabetes: A systematic review. JAMA. 2013;309(21):2250–2261.

    Article  CAS  PubMed  Google Scholar 

  13. Serrot FJ, Dorman RB, Miller CJ, et al. Comparative effectiveness of bariatric surgery and nonsurgical therapy in adults with type 2 diabetes mellitus and body mass index <35 kg/m2. Surgery. 2011;150(4):684–691.

    Article  PubMed  Google Scholar 

  14. Lee WJ, Chong K, Ser KH, Lee YC, Chen SC, Chen JC, Tsai MH, Chuang LM. Gastric Bypass vs Sleeve Gastrectomy for Type 2 Diabetes Mellitus: A Randomized Controlled Trial. Arch Surg. 2011;146(2):143–148

    Article  PubMed  Google Scholar 

  15. Choudhury RA, Murayama KM, Abt PL, Glick HA, Naji A, Williams NN, Dumon KR. Roux-en-Y gastric bypass compared with aggressive diet and exercise therapy for morbidly obese patients awaiting renal transplant: a decision analysis. Surg Obes Relat Dis. 2014

  16. Bromberger B, Porrett P, Choudhury RA, Dumon K, Murayama KM. Weight Loss Interventions for Morbidly Obese Patients with Compensated Cirrhosis: A Markov Decision Analysis Model. J Gastrointest Surg. 2014

  17. Patterson EJ, Urbach DR, Swanström LL. A comparison of diet and exercise therapy versus laparoscopic roux-en-Y gastric bypass surgery for morbid obesity: A decision analysis model. J Am Coll Surg. 2003;196(3):379–384.

    Article  PubMed  Google Scholar 

  18. Naugler WE, Sonnenberg A. Survival and cost-effectiveness analysis of competing strategies in the management of small hepatocellular carcinoma. Liver Transpl. 2010;16(10):1186–94

    Article  PubMed  Google Scholar 

  19. Magro DO, Geloneze B, Delfini R, Pareja BC, Callejas F, Pareja JC. Long-term weight regain after gastric bypass: a 5-year prospective study. Obes Surg. 2008;18(6):648–51.

    Article  PubMed  Google Scholar 

  20. Wing RR, Hill JO. SUCCESSFUL WEIGHT LOSS MAINTENANCE. Annual Review of Nutrition. 2001;21:323–341

    Article  CAS  PubMed  Google Scholar 

  21. Sjöström L, Narbro K, Sjöström CD, et al. Effects of bariatric surgery on mortality in Swedish obese subjects. N Engl J Med. 2007;357(8):741–752.

    Article  PubMed  Google Scholar 

  22. Hollenbeak CS, Rogers AM, Barrus B, Wadiwala I, Cooney RN. Surgical volume impacts bariatric surgery mortality: a case for centers of excellence. Surgery. 2008;144(5):736–43

    Article  PubMed  Google Scholar 

  23. Buchwald H, Estok R, Fahrbach K, Banel D, Sledge I. Trends in mortality in bariatric surgery: a systematic review and meta-analysis. Surgery 2007;142:621–32.

    Article  PubMed  Google Scholar 

  24. Whitlock G, Lewington S, Sherliker P, et al. Body-mass index and cause-specific mortality in 900,000 adults: collaborative analyses of 57 prospective studies. Lancet 2009;373:1083–96.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Johns Hopkins Hospital, Baltimore, MD, USA

    Rashikh A. Choudhury

  2. Abington Memorial Hospital, Philadelphia, PA, USA

    K. M. Murayama

  3. Hospital of the University of Pennsylvania, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA

    C. J. Neylan, G. Savulionyte, H. A. Glick, N. N. Williams, D. T. Dempsey & K. R. Dumon

  4. 15 Charles Plaza Unit 2504, Baltimore, MD, 21201, USA

    Rashikh A. Choudhury

Authors
  1. Rashikh A. Choudhury
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  2. K. M. Murayama
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  3. C. J. Neylan
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  4. G. Savulionyte
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  5. H. A. Glick
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  6. N. N. Williams
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  7. D. T. Dempsey
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  8. K. R. Dumon
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Correspondence to Rashikh A. Choudhury.

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Choudhury, R.A., Murayama, K.M., Neylan, C.J. et al. Re-examining the BMI Threshold for Bariatric Surgery in the USA. J Gastrointest Surg 18, 2074–2079 (2014). https://doi.org/10.1007/s11605-014-2653-7

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  • DOI: https://doi.org/10.1007/s11605-014-2653-7

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