Currently, the critieria for who qualifies for bariatric surgery typically includes a body mass index (BMI) criterion – ie, a patient has to be at a certain body weight relative to their height to qualify for surgery.
A review of data to date on the landmark SOS trial was just published by L. Sjöstrom, which I encourage anyone interested in this field to read. They have now followed SOS study patients for 20 years – though it’s noted that many patients have dropped out of the study follow up along the way, so we do have to take the results with a large grain of salt.
While there are many results in this study that are very worthy of discussing, what I wanted to point out today is that the SOS study showed a benefit of obesity surgery to decrease the risk of death, diabetes, and cardiovascular disease, as well as a decreased risk of cancer in women. What is even more interesting is that the baseline BMI did NOT predict the effect of surgery on any of these endpoints. (For those who download the article – see figure 7). Interestingly, higher baseline insulin levels did predict favorable outcomes with regards to bariatric surgery decreasing the risk of death, cardiovascular disease, and diabetes (but not cancer).
This data therefore lends further evidence to the fact that BMI criteria should not be a fixed and fast rule for who qualifies for obesity surgery and who doesn’t; looking at the whole patient and their metabolic profile (as always) is important!
Dr Sue Pedersen www.drsue.ca © 2013
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