Many people view weight loss surgery as the last-chance solution to obesity. Those who have a BMI of 40 or higher were the only ones eligible for bariatric surgery. That has changed with the release of new guidelines. Now, those with a BMI between 30 and 34.9, those who are considered mildly or moderately obese, with diabetes or metabolic syndrome can be considered candidates as well.
Dr. Joseph Colella, a leading bariatric surgeon, feels the new guidelines have many advantages. “More people who have lost the battle with their weight and are suffering from some of the significant medical consequences of obesity can now get real and effective help before it’s too late.” The new guidelines are a significant change to those established in 2020 set by the American Society for Metabolic and Bariatric Surgery, the American Association of Clinical Endocrinologists, and the Obesity Society.
The authors of the new guidelines caution that there is not enough evidence currently to promote weight loss surgery for control of blood sugar, lowering fat, or reducing risk of heart disease independent of the BMI criteria, though it can help those who meet it. “People with type 2 diabetes and a BMI over 30 do very well with bariatric surgery,” Dr. Colella said. “Resolution of their diabetes can be seen as often as 80% of the time, and this resolution is most often sustainable.”
The lowering of the BMI requirement for surgery is not the only change to bariatric surgery guidelines, though it is the most controversial. Other changes include the reclassification of sleeve gastrectomy as a proven weight loss surgery method instead of an experimental one, and the recommendation that women avoid pregnancy before weight-loss surgery and 12-18 months after surgery. There are a total of 74 new or updated guidelines that outline surgery requirements, post-operation care and surgery eligibility published in the journals Surgery for Obesity and Related Diseases, and Endocrine Practice and Obesity.
Because weight loss surgery is a relatively recent medical development, it is still one of the most studied surgical interventions. This continued study led to the change of surgery guidelines. “The reason for the change is the mountain of evidence supporting surgery as the only realistic solution for individuals with a significant weight problem and associated medical conditions,” Dr. Colella said. He added that he personally does not see any disadvantages to allowing more individuals to get bariatric surgery as long as the patient chooses “a surgeon with significant experience in bariatric surgery and one who has an excellent track record.”