The Stitch

Updated weight loss surgery guidelines offer new hope

In a monumental step forward, the bariatric and metabolic surgery world has witnessed a long-awaited transformation. The American Society for Metabolic and Bariatric Surgery (ASMBS) and the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) have unveiled a set of updated clinical guidelines, marking the first revision in over three decades. These groundbreaking recommendations bring a breath of fresh air to those seeking weight loss solutions, expanding eligibility for weight loss procedures and heralding good news regarding their safety and efficacy.

Expanded Eligibility: A Path to Better Health

Previous guidelines had confined surgical recommendations to individuals with a body mass index (BMI) of 40 or higher, or 35 if accompanied by comorbidities.

“In recognition of the significant progress made in our understanding of obesity and the role of metabolic and bariatric surgery, the ASMBS and IFSO have jointly issued this statement,” says Dr. Samer Mattar, bariatric surgeon at the Weight Loss and Metabolic Center at Baylor Medicine. “It represents a commitment to aligning surgical practices with the latest scientific knowledge and improving the quality of care provided to patients. These guidelines will allow us to help people get their health on track earlier before they are affected by serious complications of long-term obesity.”

Key highlights from the revised guidelines include:

  1. Lower BMI threshold: Bariatric surgery is now recommended for individuals with a BMI of 30 or above, irrespective of comorbidities. Individuals who have struggled to achieve substantial or lasting weight loss through non-surgical methods like diet, exercise or medications may now qualify for these life-changing procedures.
  2. Special consideration for Asian descent: The BMI requirement is further relaxed for individuals of Asian descent. Weight loss surgery is now considered for people with a BMI above 27.5, regardless of comorbidities, acknowledging the unique needs of this population.

“We see first-hand every day that bariatric surgery improves and saves lives, and we are thrilled that years of medical advancements and high-quality clinical studies are showing how safe and effective these procedures are,” Mattar says. “The new guidelines allow us to update our candidacy requirements so we can help more people reclaim their health.”

Long-term studies validate safety and effectiveness

Gastric bypass and gastric sleeve surgery have been shown to improve or even cure obesity-related conditions such as type 2 diabetes and hypertension, paving the way for healthier, happier lives.

Significant strides have been made in bariatric surgery since the last guideline update in 1991. Outdated data and traditional surgical methods contributed to the stigma surrounding these procedures. Today, 90% of bariatric surgeries in the U.S. are laparoscopic, heralding a safer and more effective era. Multiple clinical studies reinforce the effectiveness of bariatric surgery, revealing its superiority to diet and exercise. Patients continue to enjoy long-term health benefits, maintaining their weight loss successfully even 5, 10 and 20 years post-surgery.

“The 1991 NIH guidelines were groundbreaking at the time, but the medical landscape has shifted dramatically since then,” Mattar says. “We now understand obesity as a chronic disease linked to inflammation and immune dysfunction. This has paved the way for metabolic and bariatric surgery to emerge as an effective and enduring solution for severe obesity.”

By Tiffany Harston, communications associate with the Michael E. DeBakey Department of Surgery

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