Is there a role for metabolic surgery in patients with grade 1 obesity?
The global spread of obesity is driving a parallel pandemic of type-2 diabetes, a disease afflicting >171 million people worldwide, causing 3 million deaths per year. The therapeutic cornerstones for both obesity and type-2 diabetes are diet, exercise, and medication. The long-term success rates of lifestyle modifications can however be disappointing, and despite an ever-increasing pharmacotherapeutics arsenal, adequate glycemic control often remains elusive. Moreover, most diabetes medications promote weight gain, and using them to achieve tight glycemic control increases risks of hypoglycemia.
Patients with a BMI between 30 and 35 kg/m2 (class I obesity) constitute the largest class of obese persons. Millions of these individuals suffer from poorly controlled diabetes despite attempted lifestyle changes and pharmacotherapy; yet this group does not meet the current criteria for bariatric surgery.