updated guidelines for bariatric surgery
Expanding patient eligibility for weight-loss surgery and supporting metabolic surgery for people with type 2 diabetes starting at a body mass index (BMI) of 30, two of the top experts in the world on bariatric and metabolic surgery have released new evidence-based clinical guidelines that, among a slew of other recommendations, expand patient eligibility.
Most insurers and doctors still use a consensus statement from the National Institutes of Health (NIH) that was created more than 30 years ago to assess who needs weight-loss surgery, what kind of surgery they need, and when they need it.
This consensus statement will be replaced by the ASMBS/IFSO Guidelines on Indications for Metabolic and Bariatric Surgery – 2022. The American Society for Metabolic and Bariatric Surgery (ASMBS) is the largest organisation of bariatric surgeons and integrated health professionals in the United States, and the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) represents 72 national associations and societies globally.
According to Teresa LaMasters, MD, President of the ASMBS, “The 1991 NIH Consensus Statement on Bariatric Surgery served a valuable purpose for a while, but after more than three decades and hundreds of high-quality studies, including randomised clinical trials, it no longer reflects best practises and lacks relevance to today’s modern procedures and patient population.”
“For the benefit of patients, it is time for a shift in both theory and practise. It’s far past due.”
Only those with a BMI of at least 40 or a BMI of 35 or more with at least one obesity-related ailment, such as hypertension or heart disease, were considered candidates for bariatric surgery, according to the 1991 consensus statement. There were no allusions to metabolic surgery for diabetes, nor to the burgeoning laparoscopic techniques and procedures that would become conventional and make weight-loss surgery as safe as or safer than common operations like gallbladder surgery, appendectomy, and knee replacement. The statement discouraged surgery because it had not been properly examined, even for patients with BMIs over 40.
New Criteria for Patient Selection — The Times Have Changed
The ASMBS/IFSO Guidelines now advise considering metabolic and bariatric surgery for people with a BMI of 35 or higher “regardless of the presence, absence, or severity of obesity-related conditions,” as well as in “appropriately selected children and adolescents,” and for people with a BMI of 30-34.9 and metabolic disease.
However, even in those who do not have metabolic disorder, the guidelines state that if nonsurgical approaches do not result in a significant or long-lasting weight loss or alleviation of obesity-related conditions, weight-loss surgery should be considered starting at a BMI of 30. Additionally, it was suggested that Asian people start thinking about weight-loss surgery at a BMI of 27.5 and that population-based adjustments be made to the traditional BMI thresholds for defining obesity.
Greater Safety and Efficacy of Contemporary Weight-Loss Surgery
The new guidelines also state that “studies with long-term follow-up, published in the decades following the 1991 NIH Consensus Statement, have consistently demonstrated that metabolic and bariatric surgery produces superior weight loss outcomes compared with non-operative treatments” and that “metabolic and bariatric surgery is currently the most effective evidence-based treatment for obesity across all BMI classes.”
It is also said that “previous surgical operations have been replaced with safer and more successful operations,” with numerous studies demonstrating a considerable improvement in metabolic disease and a drop in overall mortality following surgery. Sleeve gastrectomy and Roux-en-Y gastric bypass (RYGB), two laparoscopic procedures, now make up nearly 90% of all operations carried out globally.
In any given year, between 1 and 2 percent of all eligible patients worldwide undergo weight-loss surgery. According to experts, the limited usage of such a treatment that has been shown to be safe and effective is a result of the unduly restrictive consensus statement from 1991. In 2016, 13% of the adult population worldwide, or more than 650 million persons, were obese. According to the CDC, over 42% of Americans are obese, which is a record high.
According to Scott Shikora, MD, President of IFSO, “The ASMBS/IFSO Guidelines give a critical reset when it comes to the treatment of obesity.”
“Insurers, governments, healthcare professionals, and patients should pay close attention and endeavour to dismantle the obstacles and antiquated assumptions that obstruct access to one of the safest, most efficient, and well researched procedures in medicine.”