New guidelines for weight-loss surgery

Credit: Andres Ayrton/ Pexels.

Weight-loss surgery, also known as bariatric surgery, is an operation that makes changes to the digestive system.

It is intended for people who have obesity and need to lose weight but have not been able to do so through other means.

In new research, scientists issued new evidence-based clinical guidelines for weight-loss surgery and endorse metabolic surgery in patients with type 2 diabetes beginning at a body mass index (BMI) of 30.

The new guidelines are meant to replace a consensus statement developed by the National Institutes of Health (NIH) more than 30 years ago.

The old guidelines set standards most insurers and doctors still rely upon to make decisions about who should get weight-loss surgery, what kind they should get, and when they should get it.

In the 1991 consensus statement, 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.

There were no references to metabolic surgery for diabetes or references to the emerging laparoscopic techniques and procedures that would become a mainstay and make weight-loss surgery as safe or safer than common operations including gallbladder surgery, appendectomy, and knee replacement.

The statement also recommended against surgery in children and adolescents even with BMIs over 40 because it had not been sufficiently studied.

The new guidelines now recommend metabolic and bariatric surgery for individuals with a BMI of 35 or more “regardless of the presence, absence, or severity of obesity-related conditions” and that it be considered for people with a BMI of 30–34.9 and metabolic disease and in “appropriately selected children and adolescents.”

But even without metabolic disease, the guidelines say weight-loss surgery should be considered starting at BMI 30 for people who do not achieve substantial or durable weight loss or obesity disease-related improvement using nonsurgical methods.

It was also recommended that obesity definitions using standard BMI thresholds be adjusted by population and that Asian individuals consider weight-loss surgery beginning at a BMI of 27.5.

The new guidelines further state metabolic and bariatric surgery is currently the most effective evidence-based treatment for obesity across all BMI classes and that studies with long-term follow-up have consistently demonstrated that metabolic and bariatric surgery produces superior weight loss outcomes compared with non-operative treatments.

It is also noted that multiple studies have shown significant improvement in metabolic disease and a decrease in overall mortality after surgery and that older surgical operations have been replaced with safer and more effective operations.

Two laparoscopic procedures, sleeve gastrectomy and Roux-en-Y Gastric Bypass (RYGB), now account for about 90% of all operations performed worldwide.

Researchers say that the ASMBS/IFSO Guidelines provide an important reset when it comes to the treatment of obesity.

Doctors 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 operations in medicine.

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The guidelines were published in Surgery for Obesity and Related Diseases (SOARD) and Obesity Surgery.

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