Evaluation of Current Eligibility Criteria for Bariatric Surgery Diabetes prevention and risk factor changes in the Swedish Obese Subjects (SOS) study

OBJECTIVEdPatients with a BMI,35 kg/m2 and patients with a BMI between 35 and 40 kg/m2 without comorbidities are noneligible by current eligibility criteria for bariatric surgery. We used Swedish obese subjects (SOS) to explore long-term outcomes in noneligible versus eligible patients. RESEARCH DESIGN ANDMETHODSdThe SOS study involved 2,010 obese patients who underwent bariatric surgery (68 % vertical-banded gastroplasty, 19 % banding, and 13% gastric bypass) and 2,037 contemporaneously matched obese controls receiving usual care. At inclusion, the participant age was 37–60 years and BMIwas$34 kg/m2 inmen and$38 kg/m2 in women. The effect of surgery was assessed in patients that do (n = 3,814) and do not (n = 233) meet current eligibility criteria. The date of analysis was 1 January 2012. The follow-up time was up to 20 years, with a median of 10 years. RESULTSdCardiovascular risk factors were significantly improved both in noneligible and eligible individuals after 10 years of follow-up. Surgery reduced the diabetes incidence in both the noneligible (adjusted hazard ratio 0.33 [95 % CI 0.13–0.82], P = 0.017) and eligible (0.27 [0.22–0.33], P, 0.001) groups.We could not detect a difference in the effect of surgery between the groups (adjusted interaction P value = 0.713)