After 30 years, medical groups have issued new guidelines for weight-loss surgery, expanding patient eligibilit­y for such surgery and endorsing metabolic surgery for patients with type 2 diabetes beginning at a body mass index (BMI) of 30, a measure of body fat based on a person’s height and weight. The ASMBS/IFSO Guidelines on Indication­s for Metabolic and Bariatric Surgery – 2022 are meant to replace a consensus statement developed by the US National Institutes of Health more than 30 years ago. 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. The statement also recommende­d against surgery in children and adolescent­s even with BMIs over 40 because it had not been sufficient­ly studied. The ASMBS/IFSO Guidelines now recommend metabolic and bariatric surgery for individual­s with a BMI of 35 or more “regardless of presence, absence, or severity of obesity-related conditions” and that it be considered for people with a BMI 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 non-surgical methods. It was also recommende­d that obesity definition­s using standard BMI thresholds be adjusted by population.

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