Literally asking for a friend. What are your thoughts on MGB for a lower BMI patient, like someone with max 40-50 lbs to lose?

I started with a BMI of 35 and had the sleeve 4 months ago.

Unless the patient has GERD, I'd tend to lean towards suggesting a sleeve for a fellow low BMI patient. Low BMI patients tend to have the the best results - on average they lose 80% of their excess weight, compared to 60% for the higher BMI patients, and many reach a normal weight. There's only ~5% difference in weight loss between the sleeve and bypass type surgeries, but bypass surgeries are more likely to lead to certain types of vitamin deficiencies in the long term. A high BMI patient might want that little extra kick of a malabsorptive procedure, while a low BMI patient is likely to not need it, so why take the extra risk?

6 minutes ago, rjan said:

I started with a BMI of 35 and had the sleeve 4 months ago.

Unless the patient has GERD, I'd tend to lean towards suggesting a sleeve for a fellow low BMI patient. Low BMI patients tend to have the the best results - on average they lose 80% of their excess weight, compared to 60% for the higher BMI patients, and many reach a normal weight. There's only ~5% difference in weight loss between the sleeve and bypass type surgeries, but bypass surgeries are more likely to lead to certain types of Vitamin deficiencies in the long term. A high BMI patient might want that little extra kick of a malabsorptive procedure, while a low BMI patient is likely to not need it, so why take the extra risk?

I am a low BMI and had my sleeve op. rjan is right, bypass causes vitamin deficiencies & are bigger ops than sleeve. Low BMI's do not seem to need it that's why the surgeons prefer sleeve.

5 hours ago, Ozzy79 said:

I am a low BMI and had my sleeve op. rjan is right, bypass causes Vitamin deficiencies & are bigger ops than sleeve. Low BMI's do not seem to need it that's why the surgeons prefer sleeve.

I think a lot of surgeons prefer the sleeve because it's easier and quicker to do. Also, vitamin deficiencies are rare in bypass patients as long as they keep on top of their vitamins.

Studies do show significant differences in nutritional deficiencies in sleeve vs. bypass.

The incidence of ND at 1 year postoperatively was generally less after SG than RYGB (34% versus 37% for zinc; 18% versus 28% for iron; 4% versus 8% for albumin; 32% versus 52% for vitamin D; and 18% versus 58% for vitamin B12) except for folate deficiency which was higher after SG than RYGB (22% versus 12%).

https://www.emjreviews.com/gastroenterology/article/nutritional-deficiency-after-sleeve-gastrectomy-a-comprehensive-literature-review/

30 minutes ago, rjan said:

Studies do show significant differences in nutritional deficiencies in sleeve vs. bypass.

The incidence of ND at 1 year postoperatively was generally less after SG than RYGB (34% versus 37% for zinc; 18% versus 28% for iron; 4% versus 8% for albumin; 32% versus 52% for Vitamin D; and 18% versus 58% for vitamin B12) except for folate deficiency which was higher after SG than RYGB (22% versus 12%).

https://www.emjreviews.com/gastroenterology/article/nutritional-deficiency-after-sleeve-gastrectomy-a-comprehensive-literature-review/

they can be more of an issue with RNY than VSG, yes, because of the malabsorption factor. But as long as RNY'ers are diligent about taking their vitamins, deficiencies are rare.

21 hours ago, rjan said:

on average they lose 80% of their excess weight, compared to 60% for the higher BMI patients, and many reach a normal weight.

This is interesting, I was not made aware of this. Can you tell me the source of this information?

21 hours ago, Band07 said:

Literally asking for a friend. What are your thoughts on MGB for a lower BMI patient, like someone with max 40-50 lbs to lose?

Well it depends on their BMI and the surgeon you're dealing with if they will even do a bypass surgery; but from experience I had the RNY bypass and had not one single issue and lost ALL my excess weight..

Your friend needs to research more before deciding if they want to put their body through surgery for only 50lbs?

3 hours ago, PlanetHopper said:

This is interesting, I was not made aware of this. Can you tell me the source of this information?

This clinic reports their results for different BMI ranges on their website; results are shown all the way up to 5 years out.

https://mercybariatrics.com.au/obesity-surgery-2/bariatrics-at-the-edge/low-bmi-patient/

1 hour ago, rjan said:

This clinic reports their results for different BMI ranges on their website; results are shown all the way up to 5 years out.

https://mercybariatrics.com.au/obesity-surgery-2/bariatrics-at-the-edge/low-bmi-patient/

interesting - looks like there's a difference if it's a size 40 bougie, but about the same if it's a size 36 bougie. I didn't have VSG so I'm not sure which size is most often used.

I had bypass surgery with a BMI of 32. I have 40-50 pounds to lose. I chose bypass because I have diabetes and the bypass helps that greatly.. I had surgery a month and a half ago and have lost just over 20 pounds. I wanted a permanent fix to get diabetes under control. Diabetes is getting better. I also had acid reflux and the sleeve can make that worse.

12 hours ago, MIKEYY84 said:

Your friend needs to research more before deciding if they want to put their body through surgery for only 50lbs?

it's a really personal decision. I thought 50 lbs would be the amount I lose and I went with having the surgery. I am really glad I did.

8 hours ago, catwoman7 said:

there's a difference if it's a size 40 bougie

great observation! I am not sure which one my surgeon used. he never mentioned it.

4 hours ago, Sueykins69 said:

Diabetes is getting better

congratulations! I am so happy that your health is improving!

On 7/8/2020 at 9:03 AM, New&Improved said:

Well it depends on their BMI and the surgeon you're dealing with if they will even do a bypass surgery; but from experience I had the RNY bypass and had not one single issue and lost ALL my excess weight..

Your friend needs to research more before deciding if they want to put their body through surgery for only 50lbs?

I have literally 50 pounds to lose (BMI 31) and "only 50lbs" is not ONLY to people with that much to lose. Although I don't have the medical necessity, I have a lot in common with my fellow sleevers when it comes to my history with weight loss, etc. The decision was not taken lightly either. I'm scheduled on Nov 30th and even though I'm nervous, I've been living with a steady weight gain and failed experiences in the past, I want to live a more fulfilling life without some of the lifestyle limitations and medical issues that could potentially be down the road.