For the first time in over 30 years, experts in the field of bariatric and metabolic surgery have released new clinical practice guidelines. These 2022 guidelines from the American Society for Metabolic and Bariatric Surgery (ASMBS) and the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) aim to update eligibility and recommendations for weight-loss surgery to reflect the latest evidence and global experience gathered since the original 1991 NIH consensus statement.
With obesity now recognized as a chronic disease, the new guidelines expand patient access to metabolic and bariatric surgery, endorsing it for a wider range of patients. Specifically, they lower the minimum body mass index (BMI) threshold and recommend considering surgery for patients with type 2 diabetes who have not responded sufficiently to lifestyle and medical management. This marks an important shift to make weight-loss surgery available to more individuals struggling with obesity and metabolic disease.
The updated ASMBS/IFSO guidelines recommend metabolic and bariatric surgery for individuals with a BMI of 35 or higher, regardless of the presence or severity of co-morbid obesity-related conditions like diabetes and hypertension. This replaces the older BMI threshold of 40 set in 1991.
Additionally, the experts suggest considering weight-loss surgery for patients with a BMI between 30-34.9 who also have metabolic disease like type 2 diabetes, if lifestyle changes and medical management have not led to sufficient improvement. This is a major shift to make surgery accessible for more individuals with class I obesity.
The new bariatric surgery guidelines also note that BMI thresholds should be adjusted for Asian populations, with obesity defined starting at 25 kg/m2. Appropriately selected adolescents may also now be candidates for metabolic surgery based on these recommendations.
The decision to expand eligibility criteria and access for weight-loss surgery is firmly grounded in the latest scientific evidence. Numerous studies over the past three decades consistently demonstrate the safety, efficacy, and durability of modern metabolic and bariatric surgery for sustained weight loss, metabolic disease improvement, and even reduced mortality.
Several long-term studies show bariatric surgery leads to over 60% excess weight loss on average that is sustained for years after the procedure. It produces superior weight loss outcomes compared to lifestyle or medical interventions alone. The significant improvement of conditions like type 2 diabetes, hypertension, sleep apnea, and dyslipidemia after surgery has also been proven in multiple studies.
Importantly, bariatric surgery has been proven safe, with very low perioperative mortality ranging from 0.03-0.2%. The operations performed have evolved and improved over time as well, with laparoscopic sleeve gastrectomy and gastric bypass now the standard procedures.
By expanding eligibility, these guidelines aim to provide access to the established benefits of metabolic and bariatric surgery to a wider population suffering from obesity and metabolic disease.
Understanding trends in bariatric surgery can give insights into the growing popularity or decline of each procedure. Below is a table illustrating the number of surgeries performed from 2011 to 2021:
Here's the statistics for bariatric surgeries performed over a ten year period:
|Year||Gastric Sleeve||RYGB||Lap Band||BPD-DS|
Key takeaways from this table:
The new rules from top experts make it easier for more people to get weight-loss surgery. These rules are based on the latest science and will help more folks struggling with weight and related health issues like diabetes. The data also shows some surgeries are getting more popular, while others are less common now.
Bottom line: More people can now consider weight-loss surgery as a real option for improving their health. This is big news that could change—and maybe even save—more lives. Keep an eye out for what comes next, as the medical field keeps learning and evolving.
For those considering or planning to undergo bariatric surgery, understanding the right diet to follow post-surgery is essential. Check out this comprehensive guide on Bariatric Foods: A Guide to a Healthy Bariatric Diet. It offers valuable insights into the types of foods suitable for each phase of your post-surgery diet.
Allison is a seasoned nutritionist and writer with over 15 years in health and weight management. She's authored journals on medical weight loss and bariatric medicine, and has specialized in bariatric foods.
Reviewed By: Dr. K. Huffman
Dr. Kevin D. Huffman, D.O., is a board-certified bariatric physician renowned for his expertise in treating obesity. With over 10,000 patients and a reputation as a national leader in bariatric medicine, he has trained hundreds of healthcare providers. Dr. Huffman develops protocols and training materials sought after by medical societies, pharmaceutical companies, patients, and hospitals.