From the Guidelines
Bariatric surgery should be considered for patients with a BMI of 40 kg/m² or greater, or those with a BMI of 35-39.9 who have obesity-related comorbid conditions, such as hypertension, impaired glucose tolerance, diabetes mellitus, hyperlipidemia, and obstructive sleep apnea, as stated in the 2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults 1. To qualify for bariatric surgery, patients should have attempted weight loss through diet and exercise without long-term success.
- A comprehensive medical evaluation, including consultations with a dietitian, psychologist, and medical specialists, is necessary to ensure patients are physically and mentally prepared for surgery.
- Patients must demonstrate an understanding of the lifestyle changes required after surgery and commit to long-term follow-up care.
- Some programs require a medically supervised weight loss program for 3-6 months before surgery approval.
- Age requirements typically range from 18 to 65, though exceptions may be made based on individual health status.
- Bariatric surgery is a significant procedure that permanently alters the digestive system, requiring lifelong dietary changes and vitamin supplementation to prevent nutritional deficiencies, as noted in the American College of Physicians' clinical practice guideline 1.
- The surgery works by restricting food intake and/or reducing nutrient absorption, leading to substantial weight loss and improvement in obesity-related conditions.
- Patients should be referred to high-volume centers with surgeons experienced in bariatric surgery, as recommended in the American College of Physicians' guideline 1, to minimize the risk of complications and ensure better outcomes.
From the Research
Qualifications for Bariatric Surgery
To qualify for bariatric surgery, individuals typically must meet certain criteria, including:
- A body mass index (BMI) of at least 40 kg/m(2) or at least 35 kg/m(2) with comorbid conditions, such as diabetes, hypertension, or dyslipidemias 2
- Failed attempts at weight loss through diet, exercise, and behavioral modification 2
- Presence of comorbid conditions associated with obesity, such as obstructive sleep apnea, weight-related arthropathies, or stress urinary incontinence 2
Bariatric Surgery for Type 2 Diabetes
Bariatric surgery has been shown to be effective in improving or resolving type 2 diabetes in patients with a BMI <35 kg/m(2) 3, 4, 5, 6
- A meta-analysis of 11 randomized clinical trials found that bariatric/metabolic surgery was superior to medical/lifestyle interventions for type 2 diabetes remission, glycemic control, and HbA1c lowering, regardless of baseline BMI 3
- Studies have shown that bariatric surgery can achieve significant weight loss, improve glycemic control, and reduce medication use in patients with type 2 diabetes and a BMI <35 kg/m(2) 4, 5, 6
Specific Procedures and Outcomes
Different bariatric surgical procedures have been shown to have varying outcomes, including:
- Malabsorptive techniques, such as Roux-en-Y gastric bypass, have been found to be more effective for weight loss and resolution of comorbid illnesses than restrictive techniques, such as adjustable gastric banding 2
- Laparoscopic sleeve gastrectomy and laparoscopic Roux-en-Y gastric bypass have been shown to be effective in improving or resolving comorbid metabolic conditions in patients with class I obesity (BMI 30-34.99 kg/m(2)) 6