NEW GUIDELINES FOR WEIGHT-LOSS SURGERY

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.