Metabolic and bariatric surgery is recommended for patients with a body mass index (BMI) of 35 kg/m2 or higher regardless of comorbid conditions, according to recent guidance.
The joint statement from the American Society for Metabolic and Bariatric Surgery and the International Federation for the Surgery of Obesity and Metabolic Disorders is intended to provide recommendations based on updated evidence published since the 1991 NIH guidelines for bariatric surgery were released. Other recommendations include the following:
- Metabolic and bariatric surgery should be considered for patients with a BMI of 30 to 34.9 kg/m2 who do not achieve substantial or durable weight loss or improvement of comorbid conditions with nonsurgical methods.
- Metabolic and bariatric surgery is recommended in patients with a BMI of at least 30 mg/kg2 and type 2 diabetes.
- BMI thresholds should be adjusted in Asian patients so that a BMI of 25 kg/m2 or greater suggests clinical obesity, and those with a BMI of 27.5 kg/m2 or greater should be offered surgery. The statement's authors said that BMI is an imperfect measure of risk stratification in patients with obesity and noted that access to metabolic and bariatric surgery should not be denied solely based on traditional BMI risk zones.
- Metabolic and bariatric surgery has no upper age limit, and clinicians should consider surgery in older patients who could benefit after careful assessment of comorbid condition and frailty.
- Severe obesity is a chronic disease requiring long-term management after primary metabolic and bariatric surgery, potentially including revisional surgery or other adjuvant therapy.
The statement also discussed metabolic and bariatric surgery in children and adolescents with obesity, as a bridge to other treatment (e.g., joint arthroplasty), and in populations at higher surgical risk. It was published jointly in Surgery for Obesity and Related Diseases on Oct. 20 and Obesity Surgery on Nov. 7.