Introduction. Moderate obesity (BMI 30–35？kg/m2) affects 25% of the western population. The role of bariatric surgery in this context is currently debated, reserved for patients with comorbidity, as an alternative to conservative medical treatment. We describe our experience in moderately obese patients treated with bariatric surgery. Materials and Methods. Between September 2011 and September 2012, 25 patients with grade I obesity and comorbidities underwent bariatric surgery: preoperative mean BMI 33.2？kg/m2, 10 males, mean age 42 years. In presence of type 2 diabetes mellitus (T2DM) (56%), gastric bypass was performed; in cases with hypertension (64%) and obstructive sleep apnea (OSA) (12%), sleeve gastrectomy was performed. All operations were performed laparoscopically. Results. Mean follow-up was 12.4 months. A postoperative complication occurred: bleeding from the trocar site was resolved with surgery in local anesthesia. Reduction in average BMI was 6 points, with a value of 27.2？kg/m2. Of the 14 patients with T2DM, 12 (86%) discontinued medical therapy because of a normalization of glycemia. Of the 16 patients with arterial hypertension, 14 (87%) showed remission and 2 (13%) improvement. Complete remission was observed in patients with OSAS. Conclusions. The results of our study support the validity of bariatric surgery in patients with BMI 30–35？kg/m2. Our opinion is that, in the future, bariatric surgery could be successful in selected cases of moderately obese patients. 1. Introduction Obesity is a world epidemic with remarkable sanitary, social, and economic consequences. Clinically, severe or morbid obesity is defined as values of BMI in the Class III (BMI ≥ 40？kg/m2) and Class II (35 ≤ BMI ≥ 39.9？kg/m2 in the presence of comorbidities). Obesity is associated with an increased hazard ratio for all-cause mortality [1], as well as significant comorbidity [2]. According to different studies, 25% of the western population is affected by some degree of obesity that can be defined as moderate or Class I obesity (BMI between 30–35？kg/m2). According to the literature, also patients with Class I obesity have a definite risk of significant comorbidity, such as diabetes mellitus, hypertension, dyslipidemia, obstructive sleep apnea syndrome, and mortality [3]. Other studies suggest that the clinical picture of patients affected by Class I obesity can be improved as well as in patients with severe obesity by bariatric surgery, with weight loss and resolution of comorbidities. The present prospective study aimed to investigate the improvements or
References
[1]
A. Berrington de Gonzales, P. Hartge, J. R. Cerhan, et al., “Body mass index and mortality among 1. 46 million white adults,” The New England Journal of Medicine, vol. 363, pp. 2211–2219, 2010, Erratum in The New England Journal of Medicine, vol. 365, p. 869, 2011.
[2]
J. Mechanick, A. Youdim, D. B. Jones et al., “Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient. 2013 update: cosponsored by American Association of Clinical Endocrinologists, the Obesity Society, and American Society for Metabolic and Bariatric Surgery,” Endocrine Practice, vol. 19, no. 2, pp. 337–372, 2013.
[3]
M. Flegal, B. K. Kit, OrpamaH, and B. I. Grandbard, “Association of all cause mortlity with overweight and obesity using standard body mass index categories: a systematic review and meta-analysis,” Journal of the American Medical Association, vol. 309, no. 1, pp. 71–82, 2013.
[4]
M. Maggard-Gibbons, M. Maglione, M. Livhits et al., “Bariatric surgery for weight loss and glycemic control in nonmorbidly obese adults with diabetes: a systematic review,” Journal of the American Medical Association, vol. 309, no. 21, pp. 2274–2275, 2013.
[5]
American College of Physicians, “NIH conference. Gastrointestinal surgery for severe obesity. Consensus development conference panel,” Annals of Internal Medicine, vol. 115, pp. 956–961, 1991.
[6]
M. Parikh, J. Duncombe, and G. A. Fielding, “Laparoscopic adjustable gastric banding for patients with body mass index of 35 kg/m2,” Surgery for Obesity and Related Diseases, vol. 2, no. 5, pp. 518–522, 2006.
[7]
J. I. Mechanick, A. J. Garbr, Y. Handelsman, et al., “American association of clinical endocrinologists (AACE) position paper on obesity and obesity medicine,” Endocrine Practice, vol. 18, pp. 642–648, 2012.
[8]
P. E. O’Brien, J. B. Dixon, C. Laurie, et al., “Treatment of mild to moderate obesity with laparoscopic adjustable gastric or an intensive medical program: a randomized trial,” Annals of Internal Medicine, vol. 2, pp. 518–522, 2006.
[9]
S. Sultan, M. Parikh, H. Youn, M. Kurian, G. Fielding, and C. Ren, “Early U.S. outcomes after laparoscopic adjustable gastric banding in patients with a body mass index less than 35 kg/m2,” Surgical Endoscopy and Other Interventional Techniques, vol. 23, no. 7, pp. 1569–1573, 2009.
[10]
L. Angrisani, F. Favretti, F. Furbetta et al., “Italian group for Lap-Band System: results of multicenter study on patients with BMI ≤35 kg/m2,” Obesity Surgery, vol. 14, no. 3, pp. 415–418, 2004.
[11]
U. S. Food and Drugs dminastration, “FDA expands use of banding system for weight loss,” http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm245617.htm.
[12]
M. Fried, G. Ribaric, J. N. Buchwald, S. Svacina, K. Dolezalova, and N. Scopinaro, “Metabolic surgery for the treatment of type 2 diabetes in patients with BMI <35 kg/m2: an integrative review of early studies,” Obesity Surgery, vol. 20, no. 6, pp. 776–790, 2010.
[13]
F. Rubino, L. M. Kaplan, P. R. Schauer, and D. E. Cummings, “The diabetes surgery summit consensus conference: recommendations for the evaluation and use of gastrointestinal surgery to treat type 2 diabetes mellitus,” Annals of Surgery, vol. 251, no. 3, pp. 399–405, 2010.
[14]
J. B. Dixon, P. E. O'Brien, J. Playfair et al., “Adjustable gastric banding and conventional therapy for type 2 diabetes: a randomized controlled trial,” Journal of the American Medical Association, vol. 299, no. 3, pp. 316–323, 2008.
[15]
F. Abbatini, D. Capoccia, G. Casella, F. Coccia, F. Leonetti, and N. Basso, “Type 2 diabetes in obese patients with body mass index of 3035 kg/m2: sleeve gastrectomy versus medical treatment,” Surgery for Obesity and Related Diseases, vol. 8, no. 1, pp. 20–24, 2012.
[16]
R. Cohen, J. S. Pinheiro, and J. L. Correa, “Laparoscopic Roux-en-Y gastric bypass for BMI<35kg/m2: a tailored approach,” Surgery for Obesity and Related Diseases, vol. 2, pp. 401–404, 2006.
[17]
J. Choi, M. Digiorgi, L. Milone et al., “Outcomes of laparoscopic adjustable gastric banding in patients with low body mass index,” Surgery for Obesity and Related Diseases, vol. 6, no. 4, pp. 367–371, 2010.
[18]
P. R. Schauer, B. Burguera, S. Ikramuddin et al., “Effect of laparoscopic Roux-En Y gastric bypass on type 2 diabetes mellitus,” Annals of Surgery, vol. 238, no. 4, pp. 467–485, 2003.
[19]
T. P. Kakoulidis, ？. Karringer, T. Gloaguen, and D. Arvidsson, “Initial results with sleeve gastrectomy for patients with class I obesity (BMI 30–35 kg/m2),” Surgery for Obesity and Related Diseases, vol. 5, no. 4, pp. 425–428, 2009.
[20]
J. Picot, J. Jones, J. L. Colquitt, E. Loveman, and A. J. Clegg, “Weight loss surgery for mild to moderate obesity: a systematic review and economic evaluation,” Obesity Surgery, vol. 22, no. 9, pp. 1496–1506, 2012.
