title: Outcomes of laparoscopic adjustable gastric banding in patients with low body mass index.
abstract: BACKGROUND
  The current National Institutes of Health guidelines have recommended bariatric surgery for patients with a body mass index (BMI) >40 kg/m(2) or BMI >35 kg/m(2) with significant co-morbidities. However, some preliminary studies have shown that patients with a BMI that does not meet these criteria could also experience similar weight loss and the benefits associated with it.
  
  
  METHODS
  An institutional review board-approved protocol was obtained to study the effectiveness of laparoscopic adjustable gastric banding in patients with a low BMI. A total of 66 patients with a BMI of 30-35 kg/m(2) and co-morbidities (n = 22) or a BMI of 35-40 kg/m(2) without co-morbidities (n = 44) underwent laparoscopic adjustable gastric banding. These patients were compared with 438 standard patients who had undergone laparoscopic adjustable gastric banding who met the National Institutes of Health criteria for bariatric surgery. The excess weight loss at 3, 6, 12, and 18 months and the status of their co-morbidities were compared between the 2 groups.
  
  
  RESULTS
  The average BMI for the study group was 36.1 +/- 2.6 kg/m(2) compared with 46.0 +/- 7.3 kg/m(2) for the control group. Both groups had significant co-morbidities, including hypertension, diabetes, hyperlipidemia, arthritis, gastroesophageal reflux disease, stress incontinence, and obstructive sleep apnea. The mean percentage of excess weight loss was 20.3% +/- 9.0%, 28.5% +/- 14.0%, 44.7% +/- 19.3%, and 42.2% +/- 33.7% at 3, 6, 12, and 18 months, respectively. This was not significantly different from the excess weight loss in the control group, except for at 12 months. Both groups showed similar improvement of most co-morbidities.
  
  
  CONCLUSIONS
  Moderately obese patients whose BMI is less than the current guidelines for bariatric surgery will have similar weight loss and associated benefits. Laparoscopic adjustable gastric banding is a safe and effective treatment for patients with a BMI of 30-35 kg/m(2).
authors.affiliation: Columbia University College of Physicians and Surgeons, New York, New York 10032, USA. Jenny1212@cox.net
authors.forename: Jenny
authors.initials: J
authors.lastname: Choi
authors.forename: Mary
authors.initials: M
authors.lastname: Digiorgi
authors.forename: Luca
authors.initials: L
authors.lastname: Milone
authors.forename: Beth
authors.initials: B
authors.lastname: Schrope
authors.forename: Lorraine
authors.initials: L
authors.lastname: Olivera-Rivera
authors.forename: Amna
authors.initials: A
authors.lastname: Daud
authors.forename: Dan
authors.initials: D
authors.lastname: Davis
authors.forename: Marc
authors.initials: M
authors.lastname: Bessler
mesh_terms: D000328:Adult; D015992:Body Mass Index; D005260:Female; D005500:Follow-Up Studies; D015391:Gastroplasty / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D009765:Obesity / Q000503:physiopathology / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome; D015431:Weight Loss / Q000502:physiology*