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Weight-loss surgery works better in moderate obesity

A BMI of less than 30 is the cut-off for obesity: Bariatric surgery is safe. FILE PHOTO | NMG
A BMI of less than 30 is the cut-off for obesity: Bariatric surgery is safe. FILE PHOTO | NMG 

Weight loss surgery works best when performed during the initial stages of obesity.

In Kenya, just as in the United States and many other countries, the procedure (medically known as bariatric surgery) is usually recommended for patients with a high body mass index (BMI) of 40 and above who are already suffering from severe or morbid obesity.

But a new study published in the JAMA Surgery journal shows that the operation yields favourable results when performed in patients with moderate obesity.

People with a BMI of between 30 and 34 are considered to have mild obesity while those with a moderate form of the condition have a BMI of between 35 and 39.

Those that cross over to the ‘40 and above’ BMI bracket suffer from severe obesity.

The researchers from the University of Michigan, Wayne State University and Henry Ford Health System studied surgery results ­­­­­of 27,320 Michigan residents who had undergone some form of bariatric surgery over a 10-year period ending in mid-2015.

They found that those who had surgery with a BMI of less than 40 were more likely to shed weight faster and get rid of obesity a year after the operation. These individuals recorded a BMI of less than 30 which is the cut off for obesity.

On the contrary, only less than nine per cent of patients achieved this goal when their pre-surgery BMI was 50 or greater.

Patients that got rid of the obesity were able to escape weight-related health risks.

By achieving a BMI of less than 30, many discontinued their medication for high cholesterol, hypertension and diabetes compared with those that did not.

These patients were also able to achieve remission of an obesity-linked breathing condition called sleep apnoea.

According to the researchers, findings of the study could help doctors to counsel prospective patients effectively about realistic expectations and the best timing for surgery.

Instead of waiting until people are severely obese before resorting to surgery as has been the common practice, the researchers recommend that the weight loss operation be performed on patients with early stage obesity.

“Bariatric surgery is extremely safe and effective and should be considered as first-line therapy for patients with a BMI between 35 and 40,” said Dr Oliver Varban, lead author of the study and director of bariatric surgery at the University of Michigan’s academic medical centre.

“Waiting for a patient to reach a BMI of over 50 only serves to limit the benefits of bariatric surgery as an intervention.”

Kenya’s Ministry of Health statistics show that more than a quarter (27 per cent) of the population is either overweight or obese.

This has led to a rapid increase in non-communicable diseases (NCDs) like diabetes, hypertension, cancer and heart disease that are now causing a significant number of deaths in the country.

Dr Miriti Kiraitu, consultant surgeon and gastrointestinal specialist at Kenyatta National Hospital, said healthy diets and physical activity are usually effective at reducing weight among individuals with mild obesity.

But as the obesity progresses, and especially among people unable to exercise or those already suffering from obesity related NCDs, he stated that weight loss surgery is required to hasten the weight reduction process.

“However, that doesn’t mean that you relax after that. After the operation, you need to embrace good nutrition and regular physical exercises for life to maintain a healthy weight.”

To successfully tackle obesity and reduce the economic burden of its health impact, Dr Kiraitu noted that the government at both national and county levels needs to come up with effective policies that guide what Kenyans eat while effectively regulating the food processing industry so as to curb unhealthy ingredients and prevent excessive advertising of unhealthy products, especially among children.

The types of bariatric surgery are duodenal switch, gastric bypass, gastric sleeve, and gastric band.

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