Weight loss surgery aims to help morbidly obese individuals drop excess pounds safely and effectively. Otherwise referred to as bariatric surgery, these procedures are aimed at those with high body mass index scores (BMI).
The body mass index was developed by professor and obesity researcher Ancel Keys in 1972. The index, which is a simple calculation of a person’s height and weight, aims to provide a uniform measurement for the amount of fat an individual is carrying.
A normal body mass index score falls between 18.5 to 24.9. Most adults fall within this range. A BMI between 25 and 29.9 indicates a person is overweight. However, a BMI of 30 or greater is described as obese.
Having a high BMI means that your body is under significant strain on account of your weight. Your organs are forced to work harder, including your heart, and your joints are placed under much more stress than someone of a normal BMI.
Most bariatric surgeries, including the ever-popular gastric sleeve and gastric bypass surgeries, are aimed at people that have high BMIs of 40 or greater or 35 with the presence of one or more obesity comorbidities.
However, some surgeries are considered low BMI procedures. Keep reading to understand more about these procedures, as well as why you would want to consider a low BMI bariatric surgery when you’ve tried everything to lose weight but to no avail.
“My Surgeon Wants me to Gain Weight Before Weight Loss Surgery?”
Weight loss surgery is often covered by insurance. For health insurance companies to cover the procedure, patients need to have a BMI of 40 or greater. The exception is that they can have a BMI of 35 with the existence of one or more obesity-comorbidities like heart disease, high blood pressure, type 2 diabetes, and osteoarthritis.
This posed a problem in the past when patients visited a bariatric surgeon with lower-than-acceptable BMIs. If a patient sought out weight loss surgery with a BMI of 30 without obesity-comorbidities, they might have been turned down for a procedure in the past. They simply weren’t heavy enough. How frustrating, right?
This led some doctors to recommend weight gain to their bariatric patients. This must have been doubly frustrating for both patients and doctors. The patient already had a hard enough time losing weight. When you become obese, your metabolism slows down. Hormone imbalances can occur in your body, making you uncontrollably hungry with no ability to satiate yourself no matter how much you eat. And even if you exercise, it takes more intense exercise at longer intervals to lose weight than someone with a normal BMI.
To compound the frustration, the very point of bariatric surgery is to lose unwanted pounds. Having to gain weight only to have surgery to lose it again seems redundant. What’s the point?
Then there is the fact that gaining weight beyond obesity levels can put your health at risk. Having a BMI in the 40 or above range makes you more susceptible to weight-related ailments. These include many cancers, along with a higher chance of early death.
Still, doctors were beholden to insurance companies who demanded that patients have a high BMI before they would cover the expenses related to bariatric surgery.
But times are changing.
Low BMI Surgeries are Safer for Bariatric Patients
The guidelines that demanded that patients have a BMI greater than 40 or 35 with major weight-related medical problems were written over four decades ago. These guidelines were put in place by the National Institutes of Health (NIH). NIH is the agency of the US government responsible for public health research. Insurance companies tend to follow NIH guidelines to the letter.
However, the American Society for Metabolic and Bariatric Surgery (ASMBS) is the governing body that presides over bariatric surgeons and bariatric surgeries in the US. The guidelines dictated by the ASMBS are updated regularly based on new research and discoveries.
One of these discoveries is that bariatric surgeries are safe for low BMI patients. The new guidelines that mention this discovery state, “For patients with a BMI of 30 to 35 kg/m2 and obesity-related comorbidities who do not achieve substantial, durable weight loss and co-morbidity improvement with reasonable nonsurgical methods, bariatric surgery should be offered as an option for suitable individuals. In this population, surgical intervention should be considered after the failure of nonsurgical treatments. Particularly given the presence of high-quality data in patients with type 2 diabetes, bariatric and metabolic surgery should be strongly considered for patients with a BMI of 30 to 35 kg/m2 and type 2 diabetes.”
Reducing Risks to the Health of Bariatric Patients
Instead of proposing that patients gain weight to qualify for surgeries like the gastric sleeve and gastric bypass, doctors are now recommending that patients lose weight prior to undergoing weight loss surgery.
This change of policy ensures that risks of complications are at an absolute minimum. For one, dropping excess pounds ahead of surgery can reduce the chances of complications from the surgery itself, which can include blood clots, infections, and heart attacks.
Right now you might be thinking that if you could lose weight before surgery, you wouldn’t be seeking weight loss surgery in the first place. You would have a valid point. When you reach the stage of obesity, your body seems to work against you. No matter how hard you try to lose weight, you either stay at the same weight as before, or you drop a few pounds only to gain them back later.
How Bariatric Surgeons Help You Lose Weight Prior to Weight Loss Surgery
Your surgeon knows that losing weight is not easy for someone with an elevated BMI. To ensure you drop the necessary pounds to make surgery safer, you may have to be on a two-week pre-surgery diet.
The average pre-bariatric-surgery diet includes:
Drinking protein powder as meal supplements adds to the protein you consume each day. The more protein you eat, the less hungry you feel, and the more weight you can potentially lose.
Your surgeon will ask you to replace fatty foods with healthier meal selections. Instead of eating fried foods, whole milk products, and fatty meats, you will replace those foods with lean meats, baked or grilled foods, and low-fat dairy products.
The surgeon asks you to replace or cut out entirely all sugary foods you eat, which includes sodas and sweets.
Fewer Carb-Heavy Foods
If you are accustomed to eating white bread, white pasta, and white rice, you may be asked to replace those foods with whole-grain options or other, healthier alternatives.
Cutting Bad Habits
In addition to choosing healthier foods, your bariatric surgeon would prefer that you refrain from health-harming habits like smoking and drinking alcohol. While you’re at it, you should practice good habits like conscious eating as opposed to binge eating.
As the day of your bariatric surgery approaches, the surgeon will ask you to refrain from taking over-the-counter medications such as ibuprofen, aspirin, and acetaminophen (Tylenol). You may also need to talk to your doctor about switching or stopping certain medications that may interfere with drugs used during your bariatric surgical procedure.
All of these points are designed to make you the healthiest possible before laying down on the surgical table. The point is to reduce your body fat, but that’s not all. Having lower body fat makes your organs perform more optimally. You will also succeed in reducing fat around your abdomen and around your liver. This will further increase your level of safety.
A high protein, low carbohydrate diet also helps you preserve and protect muscle tissue. This causes your body to use fat for energy instead of muscle, making your body healthier. You also prime your body to become a fat-burning machine post-surgery.
By placing you on a pre-surgery diet, your surgeon is preparing you for the post-surgery diet. The bariatric pre-surgery diet is very similar to the diet you are about to follow after the procedure. It includes a reduced-calorie, high-protein, low-carbohydrate, and low-fat diet. You’ll already be a professional at eating the way you should in order to maximize weight loss once the effects of surgery have taken hold.
Read our article: Gastric Sleeve Pre-Op Diet & What Happens if You Cheat?
How Much Weight Can You Lose with a Pre-Surgery Diet?
The amount of weight you stand to lose prior to bariatric surgery depends on the state of your health, your weight, and the bariatric procedure you will go under. Some bariatric surgeons prefer to lose at least 10% of your weight before clearing you for a surgery like the gastric sleeve or gastric bypass. Other surgeons would like you to lose 15 to 20 pounds to reduce the risk of complications.
What Low BMI Bariatric Procedures Do You Qualify For?
Bariatric surgeons have quite a few options when it comes to helping patients lose weight. Out of them all, gastric sleeve surgery is ideal for low BMI patients.
Otherwise known as sleeve gastrectomy, or laparoscopic sleeve gastrectomy, the gastric sleeve is particularly well-suited for patients with BMIs in the 30 to 35 range.
Unlike gastric bypass surgery, which involves the rerouting of your digestive system, gastric sleeve surgery doesn’t alter your digestion. It will only affect your stomach. This makes it a safe alternative.
The safety of the gastric sleeve is further enhanced by the techniques used during the procedure. Laparoscopic surgery involves tiny incisions and the use of serpentine tools. The surgeon uses these tools to perform the procedure inside your abdomen. This makes the surgery safer than open surgeries that force the surgeon to open your body cavity to gain access to your internal organs. As a side note, smaller incisions equate to tinier, nearly invisible scars once those incision marks have healed.
Because of these facts, gastric sleeve surgery is minimally invasive and has a lower risk than many alternative bariatric procedures.
How Much Weight Can You Lose with Low-BMI Gastric Sleeve Surgery?
Everyone responds to bariatric surgery differently. The surgeon expects you to do your part by following a sensible post-surgery diet. This should be along with getting the necessary amount of exercise. Keeping that in mind, you can expect to lose around 60% of your excess weight, on average.
Read our article: Sleeve Gastrectomy Weight Loss Timeline – How Much Can You Lose & What Can You Expect?
How Does Gastric Sleeve Help You Lose Weight?
A gastric sleeve requires the use of general anesthesia, which means you are unconscious for the duration of the procedure. In most cases, you will go home the same day, making it an outpatient procedure.
During the procedure, tiny incisions around your abdomen function as entry points for the laparoscopic tools. One of the tools involves a camera with a light. It will allow the surgeon to view the surgery on a monitor positioned in the operating room. The other tools perform the surgery, which involves the removal of 80% of your stomach tissue.
The stomach tissue that remains is fashioned into a banana-shaped sleeve. This helps to restrict the amount of food you can eat at any given time. You end up eating less after surgery and feel full faster during meals.
Hormonal changes during surgery help you feel less hungry and less deprived while regulating your blood sugar. All of these changes make weight loss easier. As long as you follow your bariatric surgeon’s recommendations for living a healthier lifestyle, you stand to lose a significant amount of weight in a relatively short amount of time.
Many patients end up losing half or more of their excess weight within the first two years following gastric sleeve surgery.
Read our article: Gastric Sleeve Surgery: How Do You Know It’s Time?
Read our article: Gastric Sleeve Surgery Insurance and How to Afford Surgery without Coverage
Are You a Suitable Candidate for Low BMI Bariatric Surgery?
If you have ever wondered if you are heavy enough for weight loss surgery, the answer may be yes, even if you don’t feel you’re necessarily morbidly obese. Low BMI surgery can help you lose weight with a slightly elevated body mass index, particularly if weight-related ailments are present like type 2 diabetes.
To find out if you are a candidate for safe and effective gastric sleeve surgery, schedule a consultation with Dr. Babak Moeinolmolki of Healthy Life Bariatrics. Call now to schedule a time that works best for you – .