Low BMI and the Path to Better Health
Defining “overweight” and “obesity” can be, and is, fiercely debated, but the powers-that-be tend to rely on body mass index or BMI to describe normal and excessive weight patterns. A BMI of 18 to 25 is normal weight, meaning normal risks for diabetes and other obesity-related health problems. When talking about treatments for over weight and obesity, the term “low BMI“ refers to those with a BMI over 27 but under 35. So what are the weight-loss surgery options for low BMI individuals?
According to the Research
You may have heard the resounding thud of large, well-funded studies failing miserably to treat obesity with any kind of success using counseling, diet, exercise, and medications. But if all those large trials of non-surgical treatments result only in short-term, minimal loss of pounds that come roaring back anyway, what are people to do?
Health insurance plans do not generally cover metabolic surgery for people in this BMI 27-35 category, but newer studies suggest that might be about to change.
A large March 2020 study among Michigan Cooperative medical centers examined the health outcomes among more than 44,000 people who underwent metabolic surgery with laparoscopic sleeve gastrectomy. Over the 12 years of the study, the low BMI individuals enjoyed major health improvements: 79% were able to drop medications they no longer needed for diabetes, and similar numbers were present for high blood pressure and sleep apnea. These low BMI individuals benefited greatly from metabolic surgery, a 45-minute procedure involving four small Band-Aids with a safety record like that of appendectomy.
Obesity is increasingly recognized as an environmental disease with very poor proven treatment options other than surgery. The surgery changes the hormonal biochemistry from tissues in the stomach and intestine that regulate body weight metabolic “setpoint” mechanisms. Without this surgical readjustment of the setpoint, only a tiny percentage of individuals can succeed with intentional weight loss, and very few of those sustain that weight more than a couple of years.
Will surgery become more accepted among individuals with a BMI 27 to 35? Will health insurance plans cover it? A few plans already do so if the patient has type 2 diabetes.
Skeptics note that there is inevitable overlap with “lifestyle” improvement that comes from metabolic surgery, namely the greater energy people experience, improved ability to exercise and enjoy outdoor activities, improved appearance, job prospects, social prospects, etc. Health insurance plans have historically not covered similar outcomes. Think of medical interventions like fertility treatment and surgery to improve visual acuity as generally requiring out-of-pocket payment.
But fundamentally, the medical data may carry the day because metabolic surgery is proving to be the safest and most effective treatment for type 2 diabetes, hypertension, sleep apnea, and a host of other medical conditions. As the latest Michigan study shows, measurable health improvements for this low BMI group are quite profound with metabolic surgery and usually result in in big reduction in the need for long-term, daily medications.
As the study authors conclude, “low-BMI patients reported high-resolution rates for diabetes, hypertension, and hyperlipidemia (>50%) and were more likely to achieve a healthy weight after SG. Abolishing the BMI threshold for SG among patients with metabolic disease should be considered.”
If you’re ready to learn more about metabolic surgery, Dr. Sasse can help. Contact the team at Sasse Surgical today.