New Bariatric Guidelines Released by Major Societies
If you have spent time researching bariatric surgery, you’ll note that the basic guidelines to qualify for surgery are pretty much set in stone. You must have a BMI of 40 or a BMI of 35 or above with one or more comorbidities (diseases associated with obesity) to qualify for most bariatric procedures. These guidelines have been in place since 1991 and have guided our decision-making in choosing the ideal patient for surgical intervention. While these guidelines have allowed millions of people to choose weight loss surgery as a long-term sustainable option, it can be argued that these relatively restrictive criteria have also limited many from getting bariatric surgery, even if their metabolic state would suggest they were good candidates. For this and several other reasons, only one to two percent of people who qualify for bariatric surgery will have the procedure.
The New Guidelines
The American Society for Metabolic and Bariatric Surgery (ASMBS) and the International Federation of Surgery for Obesity and Metabolic Disorders (IFSO) have released their joint recommendations on qualifications for bariatric surgery, and they are far more relevant to the situation today. Patients with a BMI of 30 to 34.9 with one or more obesity-related diseases should be considered for bariatric surgery. Patients with a BMI over 35 should qualify according to these new suggestions, even without weight-related diseases. The new guidelines importantly also consider the patient’s racial and ethnic background. They suggest that people of Asian descent should consider bariatric surgery at a BMI of 27.5 based on data showing they suffer from metabolic disease at a lower BMI than those of other races.
Why Have the Guidelines Changed?
The answer is straightforward – the evolution of knowledge and technology. When these guidelines were established in 1991, bariatric surgery was a very different landscape. For one, the predominant technique used at the time was open surgery, which came with several potentially significant consequences, including incisional hernias, risk of infection, blood loss, and prolonged recovery. Right around that time, we were starting to transition over to laparoscopic, minimally invasive surgery and, in doing so, reduced those risks dramatically. Today, bariatric surgery is one of the safest major surgical procedures in the United States and worldwide, with a risk profile similar to other gastrointestinal procedures like gallbladder removal.
Technique and technology have also changed, and we now have more surgical options than ever, giving patients with varying conditions additional options. For example, patients with uncontrolled or poorly controlled type two diabetes or gastroesophageal reflux may benefit the most from a gastric bypass. Those with very high BMIs may opt for the duodenal switch or SADI. Of course, a gastric sleeve is also an excellent option for most patients. These procedures have also been standardized. We know how much of the stomach to remove and where to connect limbs of the small intestine. While we take this knowledge for granted, the picture was far less clear just a decade ago, and results were more erratic. Older bariatric procedures with higher complication rates are no longer being performed. We also have far better follow-up protocols that set patients up for success long into the future.
What Do These New Guidelines Mean?
Unfortunately, new guidelines take some time to be adopted universally. However, they can and will eventually be used as guidance for policymakers, insurance companies, and physicians. Despite the delay in widespread adoption, society’s guidelines are based on the best available scientific evidence and should be considered the gold standard for what patients qualify for bariatric surgery.
The Body Mass Index
While we’re at it, it’s probably worth taking a deeper look at the body mass index and whether it is as useful as we once believed. In short, it probably shouldn’t be the only measure of qualification for bariatric surgery. Stay tuned next month on our blog to learn more about utilizing the body mass index.
Ultimately, these new guidelines are an exciting step in the right direction. We look forward to updating you when governmental and regulatory guidance has caught up to the data we have. In the meantime, if you qualify for bariatric surgery, feel free to watch our online seminar or visit us in person to learn more about your options.