When to Have Bariatric Surgery: Early or Late?

You can find plenty of bad advice about obesity in general and bariatric surgery in specific. One bit that’s especially harmful is the false notion that bariatric surgery should be “a last resort.” But a new study in JAMA Surgery provides further clarity. Putting off surgery while obesity gets progressively worse will stack the odds against a patient.

Saving Surgery for Severe Obesity

When bariatric surgery was a radical new idea, only people at a very high BMI could qualify. Guidelines focused on setting a lower limit for surgery at a BMI of 40, only after all other options failed. Health plans ask patients to prove that nothing else works for them. They ask patients to document their “failures” with everything else.

Perversely, at the same time, insurers ask patients to prove they’re highly motivated and compliant.

Better Outcomes at a Lower BMI

But the present study demonstrates better outcomes for patients before they reach a BMI of 40. The odds of putting obesity into remission – defined roughly by a BMI less than 30 – were dramatically higher for people who had surgery before they BMI reached 40 or more. Less than 30% of people in the higher BMI range achieved a remission. Compare that with more than 70% of people with a starting BMI less than 40.

And putting obesity into remission means better outcomes for the diseases that come along with obesity. Sleep apnea was more likely to clear up. People were more likely to stop needing meds for diabetes, high blood pressure, and high cholesterol.

From just about every perspective, these results make old guidelines look foolish. Can you imagine delaying treatment in a similar manner for any other chronic, progressive disease?

The shame of obesity is not in having the disease. The shame lies in treating people who have it so poorly.

Click here for the study and here for an editorial that goes with it. Click here for more perspective from the Chicago Tribune.

Late Day, photograph © michael / flickr

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August 1, 2017