Sleeve gastrectomy for first degree obesity patients |Prof.Mahmoud Zakaria
Sleeve gastrectomy for first-degree obesity patients

Sleeve gastrectomy for first-degree obesity patients

The American Society for Metabolic and Bariatric Surgery (ASMBS) recently adopted a new set of guidelines recommending surgical interventions for category 1 obese patients with a body mass index (BMI) of 30.0 to 34.9 kg/m2.

How to calculate the ideal weight?

There are two ways to calculate your ideal weight, and they are simple, as follows:

The ideal weight = Height in centimeters – 100

For example, for men whose height is 170 centimeters, their ideal weight is 70 kilograms but for women: the height is in centimeters, and subtract from it 105, the result is the perfect weight.

There is another medical method, which is more accurate:

Body mass index (BMI) = Weight in kilograms / the square of height in meters

Example: A person weighing 130 kg and height is 170 cm; the height in meters is converted to 1.7 

BMI = 130 /1.7/ 1.7 = 45 Kg/m2

How to determine your obesity grade?

If a person’s body mass index is from 18.5 to 25 Kg/m2, then that person is at his ideal weight and it is better to keep it.

The BMI of a person from 25 to 30 Kg/m2, this person suffers from excess weight, but this is not a cause for concern, in this case, he can get rid of the extra weight through diet and sports.

BMI of a person from 30 to 35 Kg/m2, this person suffers from obesity of the first degree.

BMI of a person from 35 to 40 Kg/m2, this person suffers from second-degree obesity.

A person with a BMI of more than 40 Kg/m2 suffers from morbid obesity 

The new guidelines include eight points and recommendations:

1 – Obesity in the first category is associated with several other diseases, and it reduces longevity and reduces quality of life. Obese patients require first-degree treatment.

2 – Non-surgical treatments for first-degree obesity are often ineffective.

3 – The inclusion of a body mass index of at least 35 kg/m2 was arbitrarily and firmly in the era of high-risk open surgery. Current surgical techniques for obesity and metabolic surgery are safer than they have been in the past.

4 – Bariatric surgery should be offered to suitable patients, such as those who do not achieve significant weight loss by non-surgical methods. 

5 – Patients with first-degree obesity and type 2 diabetes are strong candidates for obesity surgery.

6 – Gastric sleeve and gastric bypass surgery are safe and effective procedures for first-degree obesity.

7 – The results of these procedures in first-degree obese patients are similar to the results achieved in obese patients.

8 – Patients undergoing obesity interventions should receive long-term nutritional support before the operation. 

9- Sleeve gastrectomy is an effective treatment for type 2 diabetes and can treat this disease in the majority of patients. The costs associated with obesity surgery are much lower than the costs associated with diabetes and its long-term complications.”

Dr.  Garber, MD, chairman of Bariatric Services at Catholic Health Services, USA, also stated that he hopes insurance companies will start following these new guidelines soon.

For obese patients with a BMI of 35 or higher, surgical interventions such as sleeve gastrectomy and bypass surgery have been recommended for more than twenty years.

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What are the advantages of sleeve gastrectomy?

The course of food in the digestive system will not change after sleeve gastrectomy, and therefore there is no decrease in food absorption as in the case of gastric bypass surgery, and there is no foreign body implanted around the stomach, as in the case of the adjustable gastric band operation.

How much weight will I lose after a sleeve gastrectomy?

On average, patients lose about 70 – 80 % of their excess body weight during the first year after the operation.

In the first month: patients lose from 10-15 kg.

The first 3 months: 35 to 45% of the excess body weight.

The first 6 months: 50-60% of excess body weight.

First-year: 70 – 80% of excess body weight loss.

Most people reach their lowest weight 12-24 months after surgery.

Does the patient get better after sleeve gastrectomy as regards to obesity-related health problems?

Large clinical trials and studies have proven that sleeve gastrectomy leads to the cure or improvement of many health problems associated with obesity, such as:

  1. 1-Type 2 diabetes: Most studies indicated that 60-80% of patients suffering from type 2 diabetes could achieve a cure or improvement after gastric sleeve.
  2.  High blood pressure.
  3. Fatty liver disease.
  4. Obstructive Sleep Apnea.
  5. Cancer.
  6.  Polycystic ovaries and poor fertility in women.
  7. Depression and psychological problems.
  8.  Sterility.
  9. Low testosterone in men: Sleeve gastrectomy can increase testosterone levels.
  10.  Urine Incontinence.

What are the benefits of using Laparoscopy in sleeve gastrectomy operation?

1- Pain relief after the operation

2 – Reducing the length of hospital stay
3 – No visible wounds
4 – Faster recovery and return to normal life and work than traditional open surgery


We also use the patient-controlled analgesia painkiller (PCA) device, which prevents pain and makes the patient’s recovery faster after the operation. PCA is a method of pain relief in which the patient controls the amount of pain medicine that is used. When pain relief is needed, the person can receive a preset dose of pain medicine by pressing a button on a computerized pump that is connected to a small tube.

Initially, the laparoscopic sleeve gastrectomy was performed for very high weights (BMI over 60 kg/m2) as a first two-stage operation, and the second stage was the gastric bypass operation, which was performed after the patient reached the appropriate weight. Laparoscopic sleeve gastrectomy had proven to be very successful and many of these patients reached their ideal weight and do not require gastric bypass surgery.

Is there a problem getting pregnant later after gastric sleeve surgery?

We recommend that pregnancy be at least one year after the operation so that the body can adapt to the reduction in the size of the stomach and the amount of food. Vitamins, iron, and calcium must be taken regularly after the gastric sleeve operation for a year, and pregnant women may need additional doses of iron and calcium in consultation with a nutritionist. If Pregnancy occurs under any circumstances during the first year after the operation, the pregnant woman must have a close follow-up with a nutritionist to make sure that she consumes types of foods that are rich and beneficial to the fetus. Any medications or vitamins taken during pregnancy should be under the direct medical supervision of a gynecologist