Bariatric surgery in patients with body mass index < 35: a systematic review and meta analysis

Smith, Chris Gerard (2019) Bariatric surgery in patients with body mass index < 35: a systematic review and meta analysis. Masters thesis, Memorial University of Newfoundland.

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Abstract

Background Bariatric surgery has been shown to be safe and effective for the treatment of morbid obesity (BMI > 40 kg/m²) and some related comorbidities. The goal of the current study is to explore the role of surgery in patients with moderate obesity (BMI < 35 kg/m²). Methods Systematic review and meta analysis was performed focusing solely on patients with BMI < 35 kg/m² who underwent laparoscopic roux en y gastric bypass (RYGB), sleeve gastrectomy (LSG), or adjustable gastric banding (AGB). Data were limited to randomized controlled trials (RCT) and prospective cohort studies. Primary outcome measure was fasting plasma glucose (FPG). Secondary outcome measures included hemoglobin A1c (HbA1c), and other obesity related comorbidities. Results 13 studies were included in the analysis, 4 randomized controlled trials and 9 prospective cohort studies. Surgery was associated with significantly improved FPG compared to medical therapy (weighted mean difference (WMD) -3.24, 95% confidence interval (CI) -4.45; -2.02). Surgery was also associated with improved HbA1c, body weight, BMI loss, waist circumference, and resolution of hypertension and dyslipidemia. These results were consistent across each surgical procedure. 2 RCTs compared RYGB to LSG. There was no difference with respect to glucose metabolism however RYGB was associated with greater BMI loss (WMD -1.07, 95% CI -1.81; -0.33) and decreased waist circumference (WMD -3.51, 95% CI -6.99; -0.03). Complication rates were comparable to morbidly obese subjects. Conclusion RYGB, LSG and AGB appear to be safe and effective in the treatment of obesity and related comorbidities and should be offered to patients with BMI < 35. RYGB and LSG have similar effects on FPG and HbA1c however REYGB appears to have improved results with respect to waist circumference and BMI.

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