-- Medical Groups Replace Outdated Consensus Statement that Overly Restricts 
Access to Modern-Day Weight-Loss Surgery

NEWBERRY, Fla., Oct. 21, 2022 /PRNewswire-AsiaNet/ -- Two of the world's 
leading authorities on bariatric and metabolic surgery have issued new 
evidence-based clinical guidelines that among a slew of recommendations expand 
patient eligibility for weight-loss surgery and endorse metabolic surgery for 
patients with type 2 diabetes beginning at a body mass index (BMI) of 30, a 
measure of body fat based on a person's height and weight and one of several 
important screening criteria for surgery.

The ASMBS/IFSO Guidelines on Indications for Metabolic and Bariatric Surgery – 
2022 ( 
https://c212.net/c/link/?t=0&l=en&o=3681511-1&h=3254042605&u=https%3A%2F%2Fdoi.org%2F10.1016%2Fj.soard.2022.08.013&a=ASMBS%2FIFSO+Guidelines+on+Indications+for+Metabolic+and+Bariatric+Surgery+%E2%80%93+2022 
) , published online today in the journals, Surgery for Obesity and Related 
Diseases (SOARD) and Obesity Surgery, are meant to replace a consensus 
statement developed by National Institutes of Health (NIH) more than 30 years 
ago that set standards most insurers and doctors still rely upon to make 
decisions about who should get weight-loss surgery, what kind they should get, 
and when they should get it.

The American Society for Metabolic and Bariatric Surgery (ASMBS) ( 
https://c212.net/c/link/?t=0&l=en&o=3681511-1&h=4186307864&u=https%3A%2F%2Fasmbs.org%2F&a=ASMBS 
)  is the largest group of bariatric surgeons and integrated health 
professionals in the United States and the International Federation for the 
Surgery of Obesity and Metabolic Disorders (IFSO) ( 
https://c212.net/c/link/?t=0&l=en&o=3681511-1&h=1171923825&u=https%3A%2F%2Fwww.ifso.com%2F&a=(IFSO) 
)  represents 72 national associations and societies throughout the world.

"The 1991 NIH Consensus Statement on Bariatric Surgery served a valuable 
purpose for a time, but after more than three decades and hundreds of 
high-quality studies, including randomized clinical trials, it no longer 
reflects best practices and lacks relevance to today's modern-day procedures 
and population of patients," said Teresa LaMasters, MD, President, ASMBS. "It's 
time for a change in thinking and in practice for the sake of patients. It is 
long overdue."

In the 1991 consensus statement ( 
https://c212.net/c/link/?t=0&l=en&o=3681511-1&h=766999413&u=https%3A%2F%2Fconsensus.nih.gov%2F1991%2F1991gisurgeryobesity084PDF.pdf&a=consensus+statement 
), bariatric surgery was confined to patients with a BMI of at least 40 or a 
BMI of 35 or more and at least one obesity-related condition such as 
hypertension or heart disease. There were no references to metabolic surgery 
for diabetes or references to the emerging laparoscopic techniques and 
procedures that would become mainstay and make weight-loss surgery as safe or 
safer ( 
https://c212.net/c/link/?t=0&l=en&o=3681511-1&h=1613282092&u=https%3A%2F%2Fpubmed.ncbi.nlm.nih.gov%2F25352176%2F&a=weight-loss+surgery+as+safe+or+safer 
) than common operations including gallbladder surgery, appendectomy, and knee 
replacement. The statement also recommended against surgery in children and 
adolescents even with BMIs over 40 because it had not been sufficiently studied.

New Patient Selection Standards -- Times Have Changed

The ASMBS/IFSO Guidelines now recommend metabolic and bariatric surgery for 
individuals with a BMI of 35 or more "regardless of presence, absence, or 
severity of obesity-related conditions" and that it be considered for people 
with a BMI 30-34.9 and metabolic disease and in "appropriately selected 
children and adolescents."

But even without metabolic disease, the guidelines say weight-loss surgery 
should be considered starting at BMI 30 for people who do not achieve 
substantial or durable weight loss or obesity disease-related improvement using 
nonsurgical methods. It was also recommended that obesity definitions using 
standard BMI thresholds be adjusted by population and that Asian individuals 
consider weight-loss surgery beginning at BMI 27.5.

Higher Levels of Safety and Effectiveness for Modern-Day Weight-Loss Surgery

The new guidelines further state "metabolic and bariatric surgery is currently 
the most effective evidence-based treatment for obesity across all BMI classes" 
and that "studies with long-term follow up, published in the decades following 
the 1991 NIH Consensus Statement, have consistently demonstrated that metabolic 
and bariatric surgery produces superior weight loss outcomes compared with 
non-operative treatments."

It is also noted that multiple studies have shown significant improvement of 
metabolic disease and a decrease in overall mortality after surgery and that 
"older surgical operations have been replaced with safer and more effective 
operations." Two laparoscopic procedures, sleeve gastrectomy and Roux-en-Y 
Gastric Bypass (RYGB), now account for about 90% of all operations performed 
worldwide.

Roughly 1 to 2% of the world's eligible patient population get weight-loss 
surgery in any given year. Experts say the overly restrictive consensus 
statement from 1991 has contributed to the limited use of such a proven safe 
and effective treatment. Globally, more than 650 million adults had obesity in 
2016, which is about 13% of the world's adult population. CDC reports ( 
https://c212.net/c/link/?t=0&l=en&o=3681511-1&h=2125554376&u=https%3A%2F%2Fwww.cdc.gov%2Fnchs%2Fproducts%2Fdatabriefs%2Fdb360.htm&a=CDC+reports 
)  over 42% of Americans have obesity, the highest rate ever in the U.S.

"The ASMBS/IFSO Guidelines provide an important reset when it comes to the 
treatment of obesity," said Scott Shikora, MD, President, IFSO. "Insurers, 
policy makers, healthcare providers, and patients should pay close attention 
and work to remove the barriers and outdated thinking that prevent access to 
one of the safest, effective and most studied operations in medicine."

The ASMBS/IFSO Guidelines are just the latest in a series of new 
recommendations from medical groups calling for expanded use of metabolic 
surgery. In 2016, 45 professional societies, including the American Diabetes 
Association (ADA), issued a joint statement ( 
https://c212.net/c/link/?t=0&l=en&o=3681511-1&h=451517051&u=https%3A%2F%2Fcare.diabetesjournals.org%2Fcontent%2F39%2F6%2F861&a=joint+statement 
) that metabolic surgery should be considered for patients with type 2 diabetes 
and a BMI 30.0–34.9 if hyperglycemia is inadequately controlled despite optimal 
treatment with either oral or injectable medications. This recommendation is 
also included in the ADA's "Standards of Medical Care in Diabetes - 2022.( 
https://c212.net/c/link/?t=0&l=en&o=3681511-1&h=438180952&u=https%3A%2F%2Fdiabetesjournals.org%2Fcare%2Farticle%2F45%2FSupplement_1%2FS113%2F138906%2F8-Obesity-and-Weight-Management-for-the-Prevention&a=%22Standards+of+Medical+Care+in+Diabetes+-+2022 
)" 

Source - American Society for Metabolic and Bariatric Surgery

CONTACT: Roger Kissin, rkissin@compartnersny.com