Paul Deleeuw’s options for obesity, Bariatric Surgery or Incretins? It is the best of times to be obese. Not only are there several surgical options available, but medicines exist (incretins) that work nearly as well. What should an obese person choose?
The most important factor is how obese you are. Medical practitioners measure obesity by BMI (Body Mass Index). It is a measure of height and weight only but has proved useful. BMI over 30 is obese, 35 is seriously obese, and 40 and above is urgently obese.
The Centers for Disease Control and Prevention (CDC) defines obesity as having a BMI of 30.0 or higher.
Obesity is frequently subdivided into categories:
Class 1: BMI of 30 to < 35
Class 2: BMI of 35 to < 40
Class 3: BMI of 40 or higher.
Class 3 obesity is sometimes categorized as “extreme” or “morbid” obesity.
How do you calculate your BMI? Take your height in inches and square it. Divide that number into your weight in pounds and multiply the result by 703. Example: I am 5ft 7inches. That equals 67 inches high. Square this (67X67) is 4,489. I weigh 175 lbs. Divide 175 by 4,489 gives approximately 0.039. Multiplying that by 703 gives 27.4, my BMI.
Surgeons do it differently. They calculate your “excess weight”, how much you would have to lose to have a BMI of 25. They then measure the efficacy of any procedure or treatment by the percentage of excess weight lost. For this reason, it is difficult to compare medical weight loss with surgical, but these data are, I believe, approximately correct.
Clinical studies show that, following surgery, most patients lose weight rapidly and continue to do so until 18 to 24 months after the procedure. Patients may lose 30 to 50 percent of their excess weight in the first six months, and 77 percent of excess weight as early as 12 months after surgery. Among 240 patients with obesity, estimated mean percentage excess weight loss was 51.9% (95% CI 48.1-55.6) after gastric bypass versus 43.5% (95% CI 39.8-47.2) after sleeve gastrectomy, reported Paulina Salminen, MD, PhD, of Turku University Hospital in Finland, and colleagues in JAMA Surgery. Median weight regain, which is how much of the excess weight lost was regained in ten years, was 24.7% for gastric bypass patients versus 35% for patients who underwent sleeve gastrectomy. Other studies have shown an average of 50% of lost weight from surgery was regained in ten years.
