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New guidelines for bariatric surgery are a ‘critical reset’


The new statement calls for two metabolisms and bariatric surgery The society recommends, among other updates, expanding eligibility for bariatric surgery to include individuals with a body mass index (BMI) below current thresholds.

The statement recommends a BMI ≥ 35 kg/m as the threshold for metabolic and bariatric surgery.2regardless of complications.

In contrast, health care providers, hospitals and insurance companies now use a BMI threshold of 40 kg/m or higher.2or ≥ 35 kg/m2 Obesity-related comorbidities (such as high blood pressure Define patients eligible for metabolic and bariatric surgery based on criteria established in 1991 consensus statement by the US National Institutes of Health (NIH).

Today, the American Society of Metabolic and Bariatric Surgery (ASMBS) and the International Federation of Surgeons issued a joint statement. obesity and Metabolic Disorders (IFSO) is updating its indications for surgery to reflect advances in this field over the past 30 years.

“In light of the significant advances in understanding the disease of obesity, its management in general, and metabolic and bariatric surgery in particular, the leaders of ASMBS and IFSO, representing 72 national societies, have convened to produce the following joint statement: “The currently available scientific information on metabolic and bariatric surgery and its indications has been studied,” the authors of the document wrote.

The statement was made today at the International Obesity Congress (ICO) 2022 in Melbourne, Australia. publish online in the journal Surgery for obesity and related disorders When bariatric surgery.

Long time no see, It’s time to remove barriers

According to ASMBS and IFSO presidents, this reset of thresholds for eligibility for metabolic and bariatric surgery has been long overdue.

“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 serves a purpose. It does not reflect best practice and lacks relevance for today’s modern procedures and patient numbers,” said Teresa LaMasters, MD, president of ASMBS, in a press release.

“It’s time to change mindsets and practices for patients. It’s long overdue,” she noted.

“The ASMBS/IFSO guidelines provide an important reset when it comes to treating obesity,” added Scott Sikora, M.D., IFSO President.

“Insurers, policy makers, health care providers, and patients must take great care to remove the barriers and outdated mindsets that prevent access to one of the safest, most effective, and most researched surgeries in health care. You have to work to remove it.

The authors of the document stated that when the 1991 consensus statement was issued, the primary bariatric procedures were the no longer performed vertical band gastroplasty and Roux-en-Y gastric bypass (RYGB). I’m explaining. 90% of global operations.

Over the past three decades, based on clinical experience and research studies, our understanding of obesity and metabolic and bariatric surgery has improved significantly, and long-term studies have consistently demonstrated superior weight loss with surgery compared with non-surgical treatments. has been proven.

Major new recommendations

Below are some of the major new recommendations.

BMI≧35kg/m2: Given the existence of high-quality scientific data on the safety, efficacy and cost-effectiveness of metabolic and bariatric surgery to improve survival and quality of life in patients with BMI ≥ 35 kg/m,2Surgery should be strongly recommended in these patients regardless of the presence or absence of overt obesity-related complications.

BMI 30-34.9kg/m2: Metabolic and bariatric surgery should be considered for individuals with metabolic disease and a BMI between 30 and 34.9 kg/m.2 Those who do not achieve substantial or permanent weight loss or improvement of comorbidities using non-surgical methods.

BMI≧30kg/m2 When type 2 diabetes: Metabolic and bariatric surgery is recommended for these patients.

Lower BMI thresholds in Asians: The prevalence of diabetes and cardiovascular disease is higher in Asians with lower BMI than in non-Asians. In Asians, BMI ≥ 25 kg/m2 Patients with BMI ≥ 27.5 kg/m suggestive of clinical obesity2 Metabolic and bariatric surgery should be provided.

Properly Selected Children and Youth: Children and adolescents with a BMI >120% of the 95th percentile and major comorbidities or a BMI >140% of the 95th percentile should be considered for metabolic and bariatric surgery after evaluation by a multidisciplinary team at a specialty center. I have.

Bridge to other treatments: Metabolic and bariatric surgery is an effective treatment for clinically severe obesity in patients requiring other surgeries such as hip or knee replacement surgery. Abdominal hernia Repair, or organ transplantation.

senior citizen: There is no upper age limit for metabolic and bariatric surgery. However, elderly patients should be evaluated with caution. Frailty is associated not only with age but independently with a higher incidence of postoperative complications.

ICO 2022. Announced on October 21, 2022.

Surg Obes Relat DisPublished October 21, 2022. full text

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