Experts in the field of bariatric and metabolic surgery have recently released new guidelines, which recommend weight-loss surgery for a wider range of patients. These guidelines expand patient eligibility and endorse metabolic surgery for patients with type 2 diabetes who have a body mass index (BMI) of 30 or more. BMI is a measure of body fat that takes into account a person's height and weight, and it's one of several important screening criteria for surgery.
The American Society for Metabolic and Bariatric Surgery (ASMBS) and the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) developed these new guidelines to replace the 1991 consensus statement developed by the National Institutes of Health (NIH), which was outdated and no longer reflected best practices for weight-loss surgery. Bariatric surgery was confined to patients with a BMI of at least 40 or a BMI of 35 or more and at least one obesity-related condition such as hypertension or heart disease.
The new guidelines recommend metabolic and bariatric surgery for individuals with a BMI of 35 or more, regardless of the presence or severity of obesity-related conditions, and suggest considering it for people with a BMI of 30-34.9 and metabolic disease. Additionally, the guidelines suggest that appropriately selected children and adolescents may be eligible for surgery. The experts also recommend considering weight-loss surgery for people who do not achieve substantial or durable weight loss or obesity disease-related improvement using nonsurgical methods, even without metabolic disease.
The ASMBS/IFSO Guidelines also suggest that obesity definitions using standard BMI thresholds be adjusted by population and that Asian individuals consider weight-loss surgery beginning at BMI 27.5.
The new guidelines emphasize the safety and effectiveness of modern-day weight-loss surgery, stating that it is the most effective evidence-based treatment for obesity across all BMI classes. Studies have demonstrated that metabolic and bariatric surgery produces superior weight loss outcomes compared with non-operative treatments. Moreover, multiple studies have shown significant improvement of metabolic disease and a decrease in overall mortality after surgery. The experts also noted that older surgical operations have been replaced with safer and more effective operations. Currently, two laparoscopic procedures, sleeve gastrectomy and Roux-en-Y Gastric Bypass (RYGB), account for about 90% of all operations performed worldwide.
The ASMBS/IFSO Guidelines are an important update that should change how obesity is treated. Overly restrictive guidelines from 1991 have contributed to the limited use of this safe and effective treatment, even though more than 650 million adults had obesity in 2016, which is about 13% of the world’s adult population. In the U.S, more than 42% of Americans have obesity, which is the highest rate ever.
The ASMBS/IFSO Guidelines are not the only recommendations that call for the expanded use of metabolic surgery. In 2016, 45 professional societies, including the American Diabetes Association (ADA), issued a joint statement that metabolic surgery should be considered for patients with type 2 diabetes and a BMI of 30.0–34.9 if hyperglycemia is inadequately controlled despite optimal treatment with either oral or injectable medications. This recommendation is also included in the ADA’s “Standards of Medical Care in Diabetes – 2022.”
The ASMBS/IFSO Guidelines are a necessary and welcome update that reflects the latest research in the field of bariatric and metabolic surgery. It is crucial that insurers, policy makers, healthcare providers, and patients take these guidelines seriously to ensure that the barriers and outdated thinking preventing access to this safe and effective treatment are removed.
For more information on this, check out This Article on the ASMBS website.