In contrast , some RCT data of nonsurgical therapies show benefits at 10 years of follow-up or more .
AND RELEVANCE Current evidence suggests that , when compared with nonsurgical treatments , bariatric surgical procedures in patients with a BMI of 30 to 35 and diabetes are associated with greater short-term weight loss and better intermediate glucose outcomes .
IMPORTANCE Bariatric surgery is beneficial in persons with a body mass index ( BMI ) of 35 or greater with obesity-related comorbidities .
There is interest in using these procedures in persons with lower BMI and diabetes .
OBJECTIVE To assess the association between bariatric surgery vs nonsurgical treatments and weight loss and glycemic control among patients with diabetes or impaired glucose tolerance and BMI of 30 to 35 .
Laparoscopic adjustable gastric banding for patients with body mass index of <or=35 kg/m2.
BACKGROUND Many mild-to-moderately obese individuals ( body mass index [ BMI ] 30 - 35 kg/m(2 ) ) have serious diseases related to their obesity . Nonoperative therapy is ineffective in the long term , yet surgery has never been made widely available to this population . METHODS Between 1996 and 2004 , 93 patients with a BMI of 30 - 35 kg/m(2 ) underwent laparoscopic adjustable gastric b and ing with the LAP-B AND . All patients were referred by their primary physician , entered into a comprehensive bariatric surgery program at one Australian center , and operated on by one surgeon . Data on all patients were collected prospect ively and entered into an electronic registry . The study parameters included preoperative age , gender , BMI , presence of co-morbidities , percentage of excess weight loss , and resolution of co-morbidities . RESULTS The mean age was 44.6 years ( range 16 - 76 ) , mean weight was 98 kg , and the mean BMI was 32.7 kg/m(2 ) ( range 30 - 34 ) . Of the 93 patients , 42 ( 45 % ) had co-morbidities , including asthma , diabetes , hypertension , and sleep apnea .  The proportion of patients in follow-up was 79 % , 85 % , and 89 % at 1 , 2 , and 3 years , respectively . The mean weight was reduced to 71 kg at 1 year , 72 kg at 2 years , and 72 kg at 3 years . The mean BMI was reduced to 27.2 + /- 2.2 , 27.3 + /- 3.1 , and 27.6 + /- 3.7 kg/m(2 ) , respectively , and the mean percentage of excess weight loss was 57.9 % + /- 24.5 % , 57.6 + /- 29.3 % , and 53.8 % + /- 32.8 % at 1 , 2 , and 3 years , respectively . At 3 years , the BMI was 18 - 24 kg/m(2 ) in 34 % , 25 - 29 kg/m(2 ) in 51 % , and 30 - 35 kg/m(2 ) in 10 % . At 3 years , the percentage of excess weight loss was < 25 % in 10 % , 25 - 50 % in 24 % , 50 - 75 % in 51 % , and > 75 % in 10 % . The co-morbidities improved or completely resolved in most patients . No mortality occurred . CONCLUSION We are very encouraged by this series of low BMI patients treated with the LAP-B AND . Their weight loss has been good , the complications have been minimal , and the co-morbidities have partially or wholly resolved . With additional study , it is reasonable to expect the weight guidelines for bariatric surgery to be altered to include patients with a BMI of 30 - 35 kg/m(2 )
In contrast , some RCT data of nonsurgical therapies show benefits at 10 years of follow-up or more .
AND RELEVANCE Current evidence suggests that , when compared with nonsurgical treatments , bariatric surgical procedures in patients with a BMI of 30 to 35 and diabetes are associated with greater short-term weight loss and better intermediate glucose outcomes .
IMPORTANCE Bariatric surgery is beneficial in persons with a body mass index ( BMI ) of 35 or greater with obesity-related comorbidities .
There is interest in using these procedures in persons with lower BMI and diabetes .
OBJECTIVE To assess the association between bariatric surgery vs nonsurgical treatments and weight loss and glycemic control among patients with diabetes or impaired glucose tolerance and BMI of 30 to 35 .