Five Swearing

New Obesity Surgery Guidelines: 5 Things New

On Friday, ASMBS and IFSO announced new clinical guidelines for obesity surgery – the first update to guidelines in more than 30 years. Way back in 1991, NIH published a consensus statement that established bariatric surgery as a safe and effective option for treating severe obesity. Needless to say, we’ve learned a lot about metabolic and bariatric surgery since then, so this update is way past due.

In these new obesity surgery guidelines, you’ll find five important things that are new.

1. 35 is the New 40

Ever since 1991, the BMI threshold for bariatric surgery was 40 unless a person a person already had significant clinical complications from obesity. Back when the knowledge of long-term outcomes from bariatric surgery was more limited, that threshold made a certain amount of sense. But today, it does not. Waiting for someone to get really sick from obesity before offering an effective option for controlling it makes no sense.

Now a BMI of 35 is the threshold for surgery, even if a person has not yet developed serious complications.

2. The Threshold Is 30 if a Person Has Diabetes

With diabetes or other serious metabolic complications from obesity, the BMI threshold goes down to 30 for surgery. This makes perfect sense in light of data telling us that bariatric surgery is the most effective treatment available for putting type 2 diabetes into remission. It can prevent major complications and death.

3. In Asian Populations, the Threshold Is Lower

The new guidelines state that a BMI of 25 in Asian populations is an indication of clinically significant obesity and the threshold for bariatric surgery should be 27.5.

4. Metabolic and Bariatric Surgery Is Safe and Effective Over the Long Term

Back in 1991, data on long-term outcomes was limited, so there were always caveats about the limits of knowledge. Though surgery for any condition brings some risks, it it now clear that the long-term outcomes for bariatric surgery are good. People live longer and have fewer major complications from obesity when they have had it. Most people maintain a meaningfully lower weight over the long-term, even though some regain of weight is not unusual.

5. Pediatric Patients Deserve Access to Bariatric Surgery

Let’s be frank. This subject causes some people to lose all objectivity. For people who feel that obesity is not really a problem or people who believe it is the fault of parents and even the kids, bariatric surgery seems like something that should not be necessary.

They’re wrong.

The fact is that obesity is a real, complex, progressive, and chronic disease. For youth who suffer with it, it’s cruel to deny them access to this option, which can be life-changing. The only thing that delaying access to surgery does is to increase the likelihood of irreversible damage to the lives and long-term health of these kids.

Get the Facts, Read the Guidelines

We could go on about this, but you get the idea. These new guidelines are a big deal. Click here to read all about them, here, here, and here to get further perspective.

Five Swearing, sketch by Ferdinand Hodler / WikiArt

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October 24, 2022