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2022 American Society for Metabolic and Bariatric Surgery (ASMBS) and International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO): Indications for Metabolic and Bariatric Surgery - Surgery for Obesity and Related Diseases

Major updates to 1991 National Institutes of Health guidelines for bariatric surgery

  • Metabolic and bariatric surgery (MBS) is recommended for individuals with a body mass index (BMI) ≥35 kg/m2, regardless of presence, absence, or severity of co-morbidities.
  • MBS should be considered for individuals with metabolic disease and BMI of 30-34.9 kg/m2.
  • BMI thresholds should be adjusted in the Asian population such that a BMI ≥25 kg/m2 suggests clinical obesity, and individuals with BMI ≥27.5 kg/m2 should be offered MBS.
  • Long-term results of MBS consistently demonstrate safety and efficacy.
  • Appropriately selected children and adolescents should be considered for MBS.

Thirty years ago, the National Institutes of Health (NIH) convened a Consensus Development Conference that published a Statement on gastrointestinal surgery for severe obesity, reflecting expert assessment of the medical knowledge available at the time [1]. Specifically, it sought to address “the surgical treatments for severe obesity and the criteria for selection, the efficacy and risks of surgical treatments for severe obesity, and the need for future research on and epidemiological evaluation of these therapies,” and included specific recommendations for practice. Among these are that nonsurgical programs should be initial therapy for severe obesity; that patients should be carefully selected for surgery after evaluation by a multidisciplinary team; and that lifelong medical surveillance continue after surgery. The 1991 NIH Consensus Statement has been used by providers, hospitals, and insurers, as a standard for selection criteria for bariatric surgery. A body mass index (BMI) ≥40 kg/m2, or BMI ≥35 kg/m2 with co-morbidities, is a threshold for surgery that is applied universally.

Since its publication, hundreds of studies have been published on the worldwide obesity epidemic and global experience with metabolic and bariatric surgery (MBS), which has greatly enhanced the understanding of obesity and its treatment [2],[3]. Now recognized as a chronic disease, obesity is associated with a chronic low-grade inflammatory state and immune dysfunction [4],[5]. It is suspected that the prolonged state of inflammation leads to a disruption of homeostatic mechanisms and consequently to metabolic disorders commonly associated with obesity, mediated by incompletely elucidated pathways involving cytokine production, adipokines, hormones, and acute-phase reactants [5678].

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