American, International Organizations Debut New Bariatric and Metabolic Surgery Guidelines

Teresa LaMasters, MD

After a more than 30-year wait, bariatric and metabolic surgeons have a new set of international, evidence-based guideline recommendations for weight loss surgery.

Published on October 21 by the American Society for Metabolic and Bariatric Surgery (ASMBS) and International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO), the guideline recommendations were created with the intent of replacing those developed for the 1991 consensus statement from the National Institutes of Health and include multiple 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 practices and lacks relevance to today’s modern-day procedures and population of patients,” said Teresa LaMasters, MD, president of the ASBMS, in a statement. “It’s time for a change in thinking and in practice for the sake of patients. It is long overdue.”

A 12-page document author 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 contemporary evidence-based recommendations and cites 148 reference documents. Atop the second page of the guidelines is a brief segment highlighting 5 major updates to the 1991 NIH guidelines for bariatric surgery. These 5 major updates were:

• Metabolic and bariatric surgery is recommended for individuals with a BMI at or exceeding 35 kg/m2, regardless of presence, absence, or severity of co-morbidities.
• Metabolic and bariatric surgery should be considered for individuals with metabolic disease and BMI of 30-34.9 kg/m2.
• BMI thresholds should be adjusted in the Asian population such that a BMI at or exceeding 25 kg/m2 suggests clinical obesity, and individuals with BMI at or exceeding 27.5 kg/m2 should be offered metabolic and baraitric surgery.
• Long-term results of metabolic and bariatric surgery consistently demonstrate safety and efficacy.
• Appropriately selected children and adolescents should be considered for metabolic and bariatric surgery.

A large portion of the document is dedicated to special considerations for clinicians related to different patient populations. These considerations address extremes of age, those who are candidates for organ transplantation, and the high-risk patient, which included those with a BMI exceeding 60 kg/m2, cirrhosis, or heart failure.

“The ASMBS/IFSO Guidelines provide an important reset when it comes to the treatment of obesity,” said Scott Shikora, MD, President, IFSO. “Insurers, policy makers, healthcare providers, and patients should pay close attention and work to remove the barriers and outdated thinking that prevent access to one of the safest, effective, and most studied operations 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.