American and international organizations debut new guidelines for bariatric and metabolic surgery

American and international organizations debut new guidelines for bariatric and metabolic surgery

After more than 30 years of waiting, bariatric and metabolic surgeons have a new set of evidence-based international guidelines for weight loss surgery.

The recommendations, published on October 21 by the American Society for Metabolic and Bariatric Surgery (ASMBS) and the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO), were created with the intention of replacing the recommendations developed for the 1991 consensus statement. National Institutes of Health and include numerous changes, including expanding the patient population for metabolic and bariatric surgery to include patients with type 2 diabetes and a BMI of 30 kg/m2 or greater.

“The 1991 NIH Consensus Statement on Bariatric Surgery served a valuable purpose for a time, but after more than three decades and hundreds of high-quality studies, including randomized clinical trials, it no longer reflects best practice and lacks relevance to today’s modern practices and patient populations.” Teresa LaMasters, MD, president of ASBMS, said in a statement. “It is time for a change in thinking and practice for the benefit of patients. It’s long overdue.”

A 12-page document authored by a team of 24 international experts in obesity and metabolic and bariatric surgery, the ASBMS/IFSO guidelines were developed to provide clinicians with an overview of current evidence-based recommendations and cite 148 reference documents. On the other side of the guidelines is a short segment highlighting the 5 major updates to the 1991 NIH Bariatric Surgery Guidelines. The 5 main updates were:

  • Metabolic and bariatric surgery is recommended for individuals with a BMI of 35 kg/m2 or greater, regardless of the presence, absence, or severity of comorbidities.
  • Metabolic and bariatric surgery should be considered in individuals with metabolic disease and a BMI of 30-34.9 kg/m2.
  • BMI thresholds should be adjusted in the Asian population so that a BMI of 25 kg/m2 or higher indicates clinical obesity, and individuals with a BMI of 27.5 kg/m2 or higher should be offered metabolic and bariatric surgery.
  • Long-term results of metabolic and bariatric surgery consistently demonstrate safety and efficacy.
  • Metabolic and bariatric surgery should be considered in appropriately selected children and adolescents.

A large portion of the document is devoted to special considerations for clinicians regarding different patient populations. These considerations apply to extremes of age, those who are candidates for organ transplantation, and high-risk patients, which include those with a BMI greater than 60 kg/m2, cirrhosis, or heart failure.

“The ASMBS/IFSO guidelines provide an important reset when it comes to obesity treatment,” said Scott Shikora, MD, IFSO President. “Insurers, politicians, health care providers and patients should pay close attention and work to remove the barriers and outdated thinking that prevent access to one of the safest, most effective and most studied surgeries in medicine.”

This document “ASMBS/IFSO Guidelines on Indications for Metabolic and Bariatric Surgery – 2022” was published in Surgery for Obesity and Related Diseases (SOARD) and Obesity surgery.

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