Big News in Bariatric Surgery Guidance!
With a continued rise in obesity in the United States over the past few decades, guidelines for bariatric surgery have been slow to be updated. There’s a good reason for this. As you may know, studies are often revised, retracted, and contradicted. Some foods we thought were good for us were later deemed harmful and are now good again. Think shellfish and egg yolks. According to studies in the past couple of decades, coffee was alternately an antioxidant and a cancer-forming substance. As such, when major societies like the American Society for Metabolic and Bariatric Surgery (ASMBS) and international groups like IFSO – International Federation for the Surgery of Obesity and Metabolic Disorders – put their names to new guidelines, it’s a big deal. This is precisely what happened last month. These 2022 bariatric surgery guidelines have finally been released as guidance to update 1991 requirements from the National Institutes of Health (NIH) that were getting long in the tooth.
What Does This Updated Guidance Mean?
While this guidance is not binding, it does give governments, governmental organizations like the FDA and NIH, and insurance companies evidence-based advice that helps them update policies in the future. Of course, the degree to which they take this guidance and implement it varies, but we usually see slow movement in the right direction soon after guidelines like these are released.
The Biggest Changes in Guidance
The most significant change from 1991 to 2022 is the updated BMI (Body Mass Index) range. Prior guidance determined that bariatric surgery suits patients with a BMI of 40 or more, regardless of comorbidities. This update suggests bariatric surgery is appropriate, regardless of comorbidity status, for those with a BMI of 35 or more.
Similarly, the prior guidance of a BMI of 35 or more with comorbidities has been revised to a BMI of 30 or more. This is an acknowledgment that significant disease states can exist even at lower thresholds of obesity, which is defined as a BMI of 30 or more. It also finally addresses something we have known for a while. The dangers of excess weight vary between populations. The new guidelines suggest those of Asian descent consider bariatric surgery at a BMI of 27.5 since excess weight tends to affect Asians at a lower BMI than other races.
While SAMPA does not perform bariatric surgery on those under 18, enough research has been done on adolescent bariatric surgery to set guidelines for younger patients. Of course, it remains essential to select adolescent patients very carefully as there are pre- and post-surgical considerations adults don’t have.
The Implications of These New Guidelines
This announcement may usher in some significant changes, most revolving around the number of eligible patients who have bariatric surgery. It is estimated fewer than 2% of eligible patients are getting bariatric surgery, and patients often tell us their biggest regret is not doing it sooner. If these newer guidelines are adopted, they will broaden the availability of bariatric surgery and may increase the number of people who consider it a viable option.
Further, it is essential to note back in 1991, bariatric surgery was a very different landscape. At the time, laparoscopic surgery was only just becoming mainstream, and our technologies and knowledge were in their infancy. Complication rates were higher, and operations were less refined and standardized than they are today. As such, this new guidance may also change the perception of bariatric surgery as a last resort or as a drastic step. Bariatric surgery is as safe as gallbladder removal surgery. The complication and mortality rates are staggeringly low for such complex procedures.
Will These Guidelines Be Implemented Soon?
As we mentioned before, it will take some time for policymakers, government organizations, and insurance companies to come around and understand these new guidelines better approximate the needs of obese patients. The likelihood is eventually, some or most will make it through the regulatory process, and policies will be updated. For now, it’s essential you learn as much as possible about bariatric surgery and other weight loss options by attending one of our online or in-person bariatric seminars. Doing so can give you the knowledge and confidence to make the right decision for your circumstance.