BMI 55 and over

I'll paste a section of the article- anyone can get a password to medscape. Your choice of amusment is not mine- for the others who might find the rationale - improvement of outcomes- reduced risk of death- important- I will share this.

Superobese patients who spend an average of 9 preoperative weeks on a very-low-calorie diet (VLCD) have reduced morbidity and mortality rates associated with bariatric surgery. The weight loss regimen appears to improve factors that influence technical aspects of surgery and reduces patient comorbidities.

George M. Eid, MD, FACS, from the Division of Minimally Invasive Surgery at the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, presented the study here today at the American College of Surgeons 94th Annual Clinical Congress. The study reflected the literature on bariatric surgery that shows superobesity (body mass index [BMI] > 50 kg/m²) to be a major risk factor for adverse outcomes. Other risk factors are male sex, age, lower socioeconomic status, or smoking.

Dr. Eid noted in his presentation that the 30-day mortality rate reported for 575 bariatric surgery patients in the Veterans Administration system is 1.4%, with a 19.7% overall rate of complications. Superobese patients have a 2.3% mortality rate and a 29% morbidity rate.

The surgical risks associated with superobesity are both physiologic and technical. The physiology involves several comorbidities: diabetes mellitus, sleep apnea, congestive heart failure, hypertension, degenerative joint disease, and chronic obstructive pulmonary disease. Technical challenges include excess visceral fat, an enlarged liver (hepatomegaly), and a thickened abdominal wall.

The goal of the present study was to "evaluate changes in obesity-related comorbidities, liver size, and visceral and subcutaneous adipose tissue volumes following preoperative weight loss with a...VLCD program, and relate these changes with postoperative outcomes," said Dr. Eid.

No deaths occurred in the patients who experienced weight loss with VLCD before their bariatric surgery, even with 1-year follow-up. There were 2 postoperative complications: a questionable pulmonary embolism that was examined and had a good outcome, and a minor bleeding episode. Historical data from the same institution report 0% mortality and 6.7% morbidity rates. National Veterans Administration data for superobese patients, as noted previously, show 2.3% mortality and 29% morbidity rates.

Dr. Eid and his colleagues conclude that "bariatric surgical outcomes in superobese patients are optimized through preoperative VLCD." The significant reductions in liver volume, abdominal wall depth, and visceral adipose tissue and subcutaneous adipose tissue (technical factors) improve the surgical procedure. Improvements in diabetes, hypertension, and degenerative joint disease (physiologic factors) enhance the health of the patient.

"I had two factors. I had the technical factors and those had to do with decreasing the amount of fat and the size of the liver so we had better access to our organ and we can do a better job," Dr. Eid told Medscape Surgery. "But also we had improvement in their medical condition with diabetes and everything, so it's a two-pronged approach. On the one hand, you improve technical factors, but on the other hand you improve their comorbidities so you have less risk of complication and postoperative problems."

For superobese patients preparing for bariatric surgery, the study supports medical weight loss of 10% to 15% body weight and 6 to 8 weeks on the VLCD to reduce the risk in high-risk bariatric patients by reducing the size of the liver and improving patient comorbidities.

I did a very low cal, high protein diet from July until I had surgery in October.  Pretty sure all of the surgeons in the US require their patients to either do the low cal diet before surgery.  Next argument.

yup, mine sure did. i was instructed to lose 10-15 lbs pre-op, and i wasn't even forced to buy expensive disgusting optifast. 
 

Yep!   My surgeon wanted me to lose 10-15 lbs using a  low carb/high protein, Atkins-like diet.  Didn't get swindled into buying $200 worth of opticrap.

Dr. L asked me to lose 5lbs by cutting out some carbs and drinking water instead of pop.

He wanted me to lose 5-10 and told me to do the same thing, and to start walking every day.

I am so grateful every day for the opportunity to go stateside and be operated on by a very skilled, experienced surgeon...he used to do liver transplants...He told our class that it was necessary for us to lose 10 lbs. pre-surg., in order to shrink the liver...there were folks there with much higher bmi's than mine...Of course, this was in order to be able to do the surg. laparoscopically...I was successful at this by eating low carb...
I had to do lots of testing, incl., a stress test 'cause I'm over 50...
Nutrition classes and follow-ups are all part of the package...
There will always be folks who will screw things up, not follow recommendations,  both sides of the border...m

Yep most doctors will require you to lose a bit of weight before surgery...the reason - because your liver becomes smaller and is therefore easier to work around. But they DON't require you to become a certain BMI. So your argument re the less than 55 BMI doesn't really hold up....Again to become less than a 55 BMI, I would have needed to lose 85 lbs. But thanks....

And I think it's pretty amazing that you're arguing to have people lose all this weight on one hand and yet talk about having been discriminated against because of obesity. Isn't requiring someone to lose a bunch of weight to get down to a certain BMI before doing a surgery so desperately needed the same type of discrimination?

All of this said, I wouldn't trust my higher risk body to most of the surgeons in Ontario because they don't have enough experience to deal with me. I'd rather go OOC to a surgeon who does have experience with people as big as me (or I guess as big as I was).