Bariatrics at the edge
Careful Consideration For The Low BMI Patient
The traditional threshold for offering bariatric surgery is a BMI of 35.
If patients have a BMI lower than this we look to see if they have a genuine obesity related comorbidity, such as type 2 diabetes, hypertension, sleep apnoea, PCOS or severe joint pain which is expected to improve following surgery.
In addition patients of Asian and Indian descent often develop their comorbidities at a lower BMI than European patients and their threshold for surgery is legitimately set at a lower BMI.
Patients who have recently had a LAGB removed for a complication and whose BMI is therefore low may be offered revisional surgery at a lower BMI ( even before they reach BMI 30 ) because it is accepted that their natural history is inexorable weight regain back to their starting BMI.
The really challenging group are those with a BMI closer to 30 who have tried dieting off and on for a long time, may lose weight but always regain it. If their BMI is 34 it seems unreasonable to expect them to eat their way up to an arbitrary threshold…. But if BMI is 30?
There is no doubt that there is very little additional lifespan risk from a BMI of 30 and bariatric surgery places a patient in harm’s way which potentially could even kill them. So very serious reflection needs to be undertaken before conducting this surgery which unlike the LAGB is not reversible.
Paradoxically patients with a BMI of < 35 do better than any other cohort in terms of %EWL and based on the midsize 40 Fr bougie we typically see 90-100% EWL in the first 2 years. In fact many have lost more than 100%. Over time however their weight does drift up a little.
Mercy Bariatrics Perth
We are happy to see patients with a BMI 30-35 for discussion about surgery and take each case on its merits. We also have a non-surgical side to our practice utilising the services of our bariatric assessors, dieticians and exercise physiologists and this may be all that you need to get you into the zone that you want to be.
See our contact page for telephone, email and location details.