Can Diabetes Surgery Lead to Remission in Non-Obese Patients?
New York-Presbyterian/Weill Cornell Recruits Overweight and Mildly Obese Patients With Type 2 Diabetes for Clinical Study of Surgical Therapy
NEW YORK — Dr. Francesco Rubino, chief of gastrointestinal metabolic surgery at NewYork-Presbyterian Hospital/Weill Cornell Medical Center, is now enrolling overweight and mildly obese patients — those with a body mass index (BMI) of 28 to 35 — in a study of gastric bypass surgery aimed at reversing type 2 diabetes. Because of their non-obese status, these patients do not qualify for the surgery under current guidelines.
Today, gastric bypass, along with other bariatric procedures, can only be prescribed for patients with a BMI of 35 and over.
“The relationship between obesity and type 2 diabetes is complex and needs to be looked at closely,” says Dr. Rubino, associate professor of surgery at Weill Cornell Medical College. “Despite the strong association between the two, they don’t always go hand in hand. A significant number of people with lower BMI suffer from longstanding diabetes and its life-threatening risks and complications. Conversely, a person may be severely obese, with all the risks and quality-of-life issues that accompany that condition, but diabetes-free. For this reason alone, we need to start questioning whether BMI should be the only clinically appropriate way to decide who gets diabetes-targeted surgery.”
BMI became a parameter of eligibility for bariatric surgery about 20 years ago. A strict BMI cutoff makes sense when selecting candidates for bariatric surgery aimed at weight loss, but in Dr. Rubino’s view, it is an arbitrary and even discriminatory measure for separating those who qualify for life-saving intestinal bypass surgery from those who don’t.
“As an alternative,” Dr. Rubino explains, “patients should be triaged based on the severity of their disease, their metabolic profile, and other predictors of cardiovascular disease risk.
