Sleeve gastrectomy (SG) is not covered for patients with a body mass index (BMI)<35 kg/m2. Our goal was to determine if these patients experience the same health benefits when compared to patients with a BMI>35 kg/m2.


Using a statewide bariatric-specific data registry, we identified all patients with a BMI<35 kg/m2who underwent primary SG (n=333) between 2006 and 2017. Patient characteristics, 30-day risk adjusted complication rates and patient reported outcomes were compared to those who underwent a SG with a BMI>35 kg/m2during the same time period (n=41,172).


BMI<35 kg/m2patients were more likely to be older (48.8 years vs 45.5 years, p<0.0001), female (86.8% vs 77.9%, p=0.0001) and have hyperlipidemia (53.8% vs 45.5%, p=0.0024), when compared to BMI>35 kg/m2patients. Overall complication rates were comparable (6.9% vs 5.2%, p=0.1756) as were discontinuation of medications for hypertension (55.8% vs 53.9%, p=0.7345), hyperlipidemia (51.9% vs 52.6%, p=0.9266) and diabetes (oral, 85.7% vs 78.1%, p=0.2326; insulin, 52.2% vs 62.4%, p=0.3173). BMI<35 kg/m2patients were more likely to achieve a normal BMI (ie. BMI<25 kg/m2) (40.7% vs 6.7%, p<0.0001) and also had higher psychological well-being scores (77.9 vs 73.0, p=0.0012), body image scores (52.0 vs 42.6, p<0.0001) and satisfaction rates (90.9% vs 84.6%, p=0.0405).


Low BMI patients were more likely to achieve a normal body weight, have better quality of life and satisfaction after SG. In addition, rates of patient reported resolution of metabolic disease remains high (>50%). Lowering the BMI threshold for sleeve gastrectomy should be considered.