Indications for obesity surgery

What are the indications for obesity surgery?

A National Institutes of Health (NIH) Consensus Conference held in 1991 recommended that the following patients be considered for bariatric surgery:

• BMI ≥ 40 kg/m 2

• BMI of 35 to 40 kg/m if associated with other severe obesity-related medical problems that are likely to improve with weight reduction (i.e., hypertension, diabetes mellitus, obstructive sleep apnea)

Are there other important inclusion criteria for surgery?

The initial medical and surgical history and physical examination will determine a person’s eligibility for bariatric surgery. The patient must meet the 1991 NIH Consensus Conference weight criteria, as discussed above. The patient must also clear psychological testing and evaluation and preferably have a referral from their primary care provider or internist. Endocrine disorders, such as hypothyroidism and Cushing’s disease, should be ruled out, as should any medications causing weight gain. A documented history of failed prior weight loss attempts through dietary, behavioral, lifestyle, and/or medical interventions must be reviewed and verified. Last, but most important, the patient must be motivated and have a basic understanding of the procedure, its risks, benefits, complications, and long-term outcomes prior to any further evaluation for surgery.

Have there been any recent updates to the classic surgical indications listed above?

• The U.S. Food and Drug Administration in 2011 expanded the use of the Lap Band to include obese individuals who have a BMI of 30 to 34 kg/m and also have an existing obesity-related comorbidity.

• The International Diabetes Federation in its 2011 position statement, as well as the American Diabetes Association in its recent position statement, stated that surgery should be considered a treatment option in patients who have type 2 diabetes mellitus and a BMI between 30 and 34.9 kg/m if hyperglycemia cannot be adequately controlled by an optimal medical regimen.


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