The American Society for Metabolic and Bariatric Surgery (ASMBS) recently adopted a new set of guidelines that recommend surgical interventions for Class I obesity patients, who have a Body Mass Index (BMI) from 30.0 to 34.9 kg/m2. Obese patients with a BMI of 35 or higher have met the criteria for surgical interventions for more than two decades.
The new guidelines feature eight points and recommendations:
- Class I obesity is linked to several other diseases, decreases longevity, and diminishes quality of life. Class I obesity patients need durable treatment.
- Nonsurgical treatments for Class I obesity are often ineffective.
- The longstanding BMI inclusion threshold of at least 35 kg/m2 is arbitrary and was established in the era of high-risk open surgery. Current surgical techniques for bariatric and metabolic surgery are much safer than in the past.
- For patients with Class I obesity, bariatric surgery should be offered for suitable patients such as those who do not achieve substantial weight loss with nonsurgical methods.
- Patients with Class I obesity and Type 2 diabetes are strong candidates for bariatric surgery.
- The primary laparoscopic surgical interventions for obesity—adjustable gastric banding, Roux-en-Y gastric bypass and sleeve gastrectomy—are safe and effective in the treatment of Class I obesity. The results of these procedures in Class I obesity patients are similar to results achieved in severely obese patients.
- Patients who undergo surgical interventions for obesity should receive perioperative and long-term nutritional, metabolic, and nonsurgical support such as measures in the ASMBS Clinical Practice Guidelines.
- For Class I obesity patients, the best evidence for bariatric and metabolic surgery supports the procedures for patients aged 18 to 65.
Shawn Garber, MD, chairman of Bariatric Services at Catholic Health Services and founder and director of the New York Bariatric Group, reacted to this news.
He said, “The new guidelines by the ASMBS for bariatric surgery will hopefully help increase access to care to treat obesity. Bariatric surgery or “diabetes surgery” has been shown to be the most effective treatment for Type 2 Diabetes and can cure this disease in the majority of patients. The costs associated with bariatric surgery are much less than the cost associated to treat diabetes and its long-term complications. I’m hoping that insurance companies will start to follow these new guidelines soon.”
Bariatric surgery is performed on patients who are approximately 100 pounds or more overweight and have been unsuccessful with diet and exercise programs, and weight-loss medications. Someone who is 60–80 pounds overweight may qualify if he or she has a medical condition related to obesity. Obesity can also lead to other illnesses from chronic to acute, including high blood pressure, coronary artery disease, coronary vascular disease, heart attack, stroke and even cancer.
To connect with Dr. Garber, call 516-705-3947.
