From the Guidelines
Bariatric surgery is indicated for individuals with a BMI ≥ 35 kg/m2 or a BMI ≥ 30 kg/m2 with weight-related complications, such as type 2 diabetes.
Criteria for Bariatric Surgery
The following are the criteria for bariatric surgery:
- BMI ≥ 35 kg/m2 or
- BMI ≥ 30 kg/m2 with weight-related complications, such as type 2 diabetes 1
- Failed non-surgical weight loss interventions 1
- Acceptable operative risks and ability to comply with long-term treatment and follow-up 1
Important Considerations
- Comprehensive multidisciplinary assessment is necessary before offering surgery 1
- Lifelong commitment to prevent weight regain and monitoring for nutrient deficiency and obesity-related complications is required 1
- Experienced multidisciplinary team is necessary for management, including a surgeon, bariatric physician, dietitian, physiotherapist, and psychologist or psychiatrist 1
Benefits and Risks
- Benefits: significant and sustained weight loss, improvement or resolution of obesity-related complications, and reduced risk of mortality 1
- Risks: surgical complications, nutritional deficiencies, and potential for weight regain 1
From the Research
Criteria for Bariatric Surgery
The criteria for bariatric surgery include:
- Body Mass Index (BMI) of 40 or higher, or 35 or higher with serious obesity-related comorbidities, as recommended by the 1991 National Institutes of Health guidelines 2
- BMI of 30-35 with inadequately controlled type 2 diabetes despite optimal medical treatment 2
- Severity of comorbidities, such as prediabetes, diabetes, hypertension, dyslipidemia, sleep apnea, venous stasis disease, chronic joint pain, and gastroesophageal reflux, as considered in the development of appropriateness criteria for bariatric surgery 3
- Age, with consideration of extreme age groups (e.g. adolescents and elderly) and their appropriateness for surgery based on comorbidity severity 3
Updates to Indications for Bariatric Surgery
Recent updates to the indications for bariatric surgery include:
- The American Society of Metabolic and Bariatric Surgery (ASMBS) and the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) recommending bariatric surgery for patients with a BMI ≥35 kg/m2 regardless of comorbidities, and 30-34.9 kg/m2 with obesity-related comorbidities 4
- Expansion of eligibility criteria for metabolic surgery to patients with diabetes mellitus and a BMI of 30-35 kg/m2 5
Considerations for Patient Selection
Patient selection for bariatric surgery should consider: