Two of the world’s leading authorities on bariatric and metabolic surgery have published new evidence-based clinical guidelines. Among its many recommendations, the guidelines expand a patient’s eligibility for debulking surgery and recommend metabolic surgery for patients with type 2 diabetes. BMI) 30, a measure of body fat based on a person’s height and weight, and is one of several important screening criteria for surgery.
of ASMBS/IFSO Guidelines on Indications for Metabolic and Bariatric Surgery — 2022published online today in the journal, Surgery for Obesity and Related Disorders (SOARD) When bariatric surgeryis intended to replace the consensus statement developed by the National Institutes of Health (NIH) more than 30 years ago.
The American Society for Metabolic and Bariatric Surgery (ASMBS) is the largest group of bariatric surgeons and holistic medical professionals in the United States, and the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) is a group of 72 countries worldwide. It represents the association and society. .
“The 1991 NIH Consensus Statement on Bariatric Surgery served a worthy purpose for some time, but after over 30 years of hundreds of high-quality studies, including randomized clinical trials, it no longer represents best practice. It does not reflect and lacks relevance to today’s modern procedures and patient populations,” said Teresa LaMasters, M.D., Ph.D., president of ASMBS. “It’s time to change mindsets and practices for patients. It’s been long overdue.”
A 1991 consensus statement restricted bariatric surgery to patients with a BMI of 40 or greater or 35 or greater and at least one obesity-related condition, such as hypertension or heart disease. References to metabolic surgery for diabetes and new laparoscopic techniques and procedures that have become mainstream and are safer or safer than common surgeries such as gallbladder surgery, appendectomy, knee replacement, etc. No. This statement also recommends against surgery in children and adolescents, even those with a BMI greater than 40, because it has not been well studied.
New patient inclusion criteria — time has changed
ASMBS/IFSO guidelines currently recommend metabolic and bariatric surgery “regardless of the presence or severity of obesity-related conditions” for individuals with a BMI of 35 or greater, and those with a BMI of 30–34.9 and metabolic disease. I encourage people who have it to consider it. and “well-chosen children and adolescents.”
However, for individuals without metabolic disease who do not achieve substantial or permanent weight loss or obesity-related improvement using nonsurgical methods, weight loss surgery should be considered starting with a BMI of 30. The guidelines state that there are It was also recommended that the definition of obesity using her standard BMI threshold be adjusted by population and that Asians consider starting weight loss surgery from her BMI of 27.5.
Higher Levels of Safety and Effectiveness of Modern Weight Loss Surgery
The new guidelines further state that “metabolic surgery and bariatric surgery are currently the most effective evidence-based treatments for obesity in all BMI classes,” adding that “there are dozens of new treatments following the 1991 NIH Consensus Statement.” Studies published over the years, with long-term follow-up, have consistently demonstrated that metabolic and bariatric surgery yields superior weight loss results compared to non-surgical treatments.”
Also, multiple studies have shown significant improvement in metabolic disease and a reduction in overall mortality after surgery, suggesting that ‘older surgeries are being replaced by safer and more effective procedures.’ Two laparoscopic surgeries, sleeve gastrectomy and Roux-en-Y gastric bypass (RYGB), currently account for about 90% of all surgeries performed worldwide. .
Approximately 1-2% of the global eligible patient population undergoes weight loss surgery in any given year. Experts say an overly restrictive consensus statement from 1991 contributed to the limited use of such proven safe and effective treatments. Globally, more than 650 million of her adults were obese in 2016, representing approximately 13% of the world’s adult population. The CDC reports that more than 42% of her Americans are obese, the highest percentage ever in America.
“The ASMBS/IFSO guidelines provide an important reset when it comes to treating obesity,” said Scott Sikora, M.D., IFSO President. “Insurers, policy makers, providers and patients are taking great care to remove barriers and outdated mindsets that prevent access to one of the safest, most effective and most researched procedures in health care. We have to work for it.”
The ASMBS/IFSO guidelines are the latest in a series of new recommendations from the medical community calling for expanded use of metabolic surgery. In 2016, 45 professional societies, including the American Diabetes Association (ADA), issued a joint statement stating that people with type 2 diabetes with a BMI of 30.0 to 34.9 have hyperglycemia despite optimal treatment with oral or oral medications. is inadequately controlled, metabolic surgery should be considered. injectable medicine. This recommendation is also included in the ADA’s Standards of Care in Diabetes — 2022.
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