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The Cutting Edge - Researching Bariatric Surgery for Patients with Low BMI and Type 2 Diabetes

Cutting Edge Summer 2014

Researching Bariatric Surgery for Patients with Low BMI and Type 2 Diabetes

Date: July 18, 2014


Michael Schweitzer and colleagues want to know whether weight loss from bariatric surgery can resolve diabetes in patients with a BMI between 30 and 40.
Michael Schweitzer and colleagues want to know whether weight loss from bariatric surgery can resolve diabetes in patients with a BMI between 30 and 40.

When it comes to weight loss surgery, it’s not enough to be obese. To qualify, patients must also meet a rigorous set of requirements—morbid obesity chief among them.

That means having a body mass index (BMI) of 40 or higher. Patients with a BMI between 35 and 40 may qualify, but only if they have a serious, related health problem that can be addressed with weight loss, such as type 2 diabetes, severe sleep apnea or high blood pressure. Meanwhile, surgical candidates must also prove that repeated efforts at losing weight through diet and exercise have failed. But being a few pounds shy of morbid obesity doesn’t mean someone will find losing weight any easier. And weight-related diseases or disorders aren’t unique to patients with a BMI of 35 or higher. Realistically, anyone who’s overweight faces an increased risk of weight-related health problems. And for any one of these people—morbidly obese or not—one of the best chances at alleviating comorbid conditions is losing weight.

Weight loss surgery benefits for patients with diabetes, higher BMI

Falling short of bariatric surgery qualifications, however, doesn’t mean a patient might not benefit from the procedure, says bariatric surgeon Michael Schweitzer, director of the Johns Hopkins Center for Bariatric Surgery at Johns Hopkins Bayview Medical Center. For instance, he says, take patients with type 2 diabetes. Increasing evidence indicates that diabetics can have better outcomes following weight loss surgery—including those who don’t meet the traditional BMI requirement. With that in mind, Schweitzer and his colleagues are running a clinical trial offering bariatric surgery—either laparoscopic band or gastric bypass—to diabetic patients with a BMI between 30 and 40. The idea, he says, is to see whether the resulting weight loss ultimately leads to resolution of their diabetes or other comorbidities.

“This trial includes those patients with a lower BMI,” Schweitzer says. “In the past, those patients weren’t offered surgery. But gastric bypass and laparoscopic band surgery have both shown excellent results in resolving health problems compared to diet alone.”

Weight loss surgery can be particularly valuable to those with type 2 diabetes, who can be particularly prone to weight gain. “Eighty percent of type 2 diabetics are overweight,” Schweitzer says. “Most diabetic medications make you gain weight, so they make the problem worse. If you don’t intervene and solely give them medication, in the long run they gain weight and could have worse outcomes.”

To find out more about this trial or more of Schweitzer’s ongoing research, call 410-550-0409.

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