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 .
Early U.S. outcomes after laparoscopic adjustable gastric banding in patients with a body mass index less than 35 kg/m2
Background Many mildly to moderately obese individuals with a body mass index ( BMI ) lower than 35 kg/m2 have serious diseases related to their obesity . Nonsurgical therapy is ineffective in the long term , yet surgery has never been made widely available to this population . Methods Between 2002 and 2007 , 53 patients with a BMI lower than 35 kg/m2 underwent laparoscopic adjustable gastric b and ing at our institution . Data on all these patients were collected prospect ively and entered into an institutional review board – approved electronic registry . The study parameters included preoperative age , gender , BMI , presence of comorbidities , percentage of excess weight loss ( % EWL ) , and resolution of comorbidities . Results The mean preoperative age of the patients was 46.9 years ( range , 16–68 years ) , and the mean preoperative BMI was 33.1 kg/m2 ( range , 28.2–35.0 kg/m2 ) . Of the 53 patients , 49 ( 92 % ) had at least one obesity-related comorbidity . The mean BMI decreased to 28.1 ± 2.4 kg/m2 , 25.8 ± 2.9 kg/m2 , and 25.8 ± 3.1 kg/m2 and mean % EWL was 48.3 ± 17.6 , 69.9 ± 28.0 , and 69.7 ± 31.7 at 0.5 , 1 , and 2 years , respectively . Substantial improvement occurred for the following comorbidities evaluated : hypertension , depression , diabetes , asthma , hypertriglyceridemia , obstructive sleep apnea , hypercholesterolemia , and osteoarthritis . There was one slip , two cases of b and obstruction ( from food ) , two cases of esophagitis , and two port leaks , but no mortality . Conclusion The authors are very encouraged by this series of low- BMI patients who underwent laparoscopic adjustable gastric b and ing .  Their weight loss has been excellent , and their complications have been acceptable . Their comorbidities have partially or wholly resolved . With further study , it is reasonable to expect alteration of the weight guidelines for bariatric surgery to include patients with a BMI lower than 35 kg/m2
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 .