Scientific Evidence for the Updated Guidelines on Indications for Metabolic and Bariatric Surgery (IFSO/ASMBS) - Scorecard - MDSpire

Scientific Evidence for the Updated Guidelines on Indications for Metabolic and Bariatric Surgery (IFSO/ASMBS)

  • By

  • Maurizio De Luca

  • Scott Shikora

  • Dan Eisenberg

  • Luigi Angrisani

  • Chetan Parmar

  • Aayed Alqahtani

  • Ali Aminian

  • Edo Aarts

  • Wendy Brown

  • Ricardo V. Cohen

  • Nicola Di Lorenzo

  • Silvia L. Faria

  • Kasey P. S. Goodpaster

  • Ashraf Haddad

  • Miguel Herrera

  • Raul Rosenthal

  • Jacques Himpens

  • Angelo Iossa

  • Mohammad Kermansaravi

  • Lilian Kow

  • Marina Kurian

  • Sonja Chiappetta

  • Teresa LaMasters

  • Kamal Mahawar

  • Giovanni Merola

  • Abdelrahman Nimeri

  • Mary O’Kane

  • Pavlos Papasavas

  • Giacomo Piatto

  • Jaime Ponce

  • Gerhard Prager

  • Janey S. A. Pratt

  • Ann M. Rogers

  • Paulina Salminen

  • Kimberley E. Steele

  • Michel Suter

  • Salvatore Tolone

  • Antonio Vitiello

  • Marco Zappa

  • Shanu N. Kothari

  • September 25, 2024

  • 0 min

Share

Clinical Scorecard: Evidence Supporting Revised Recommendations for Metabolic and Bariatric Surgery Indications (IFSO/ASMBS)

At a Glance

CategoryDetail
ConditionSevere obesity and obesity-associated medical conditions
Key MechanismsMetabolic and bariatric surgery (MBS) induces weight loss and remission of comorbidities such as type 2 diabetes mellitus and hypertension
Target PopulationPatients with obesity, including those with BMI 30–34.9 kg/m2 with comorbidities, and higher BMI categories
Care SettingSpecialized metabolic and bariatric surgery centers with multidisciplinary teams

Key Highlights

  • 1991 NIH criteria for bariatric surgery candidacy are outdated and do not reflect current surgical techniques or evidence.
  • ASMBS and IFSO collaborated to update guidelines based on systematic reviews and expert consensus using PRISMA methodology and Delphi surveys.
  • MBS is recommended for patients with BMI 30–34.9 kg/m2 with type 2 diabetes or one obesity-associated medical problem, with evidence level 2a and grade B recommendation.

Guideline-Based Recommendations

Diagnosis

  • Assess BMI and presence of obesity-associated medical problems such as type 2 diabetes mellitus and hypertension.
  • Use updated criteria rather than relying solely on 1991 NIH guidelines.

Management

  • Recommend MBS for patients with BMI 30–34.9 kg/m2 and type 2 diabetes or one obesity-associated medical problem.
  • Consider MBS for patients with BMI 30–34.9 kg/m2 who do not achieve durable weight loss or comorbidity improvement with nonsurgical methods.
  • Select surgical procedure based on current best practices including sleeve gastrectomy, Roux-en-Y gastric bypass, and others.

Monitoring & Follow-up

  • Perform long-term follow-up to monitor weight loss, remission of comorbidities, and surgical complications.
  • Track operative time, length of stay, and complication rates using standardized classifications such as Clavien–Dindo.

Risks

  • Complication rates vary by procedure; revisional surgeries have higher complication rates.
  • Clavien–Dindo grade 3–4 complications reported up to 40% in some procedures like biliopancreatic diversion.
  • No mortality reported in reviewed studies for BMI 30–34.9 kg/m2 patients undergoing MBS.

Patient & Prescribing Data

Patients with BMI 30–34.9 kg/m2 with type 2 diabetes or one obesity-associated medical problem

MBS leads to satisfactory weight loss and remission rates for T2DM (33–100%) and hypertension (28–100%) with acceptable safety profile.

Clinical Best Practices

  • Use evidence-based updated criteria for patient selection rather than outdated NIH 1991 guidelines.
  • Incorporate multidisciplinary evaluation and follow-up in accredited MBS centers.
  • Apply systematic review and expert consensus data to guide surgical procedure choice and patient counseling.

References

Original Source(s)

Scientific Evidence for the Updated Guidelines on Indications for Metabolic and Bariatric Surgery (IFSO/ASMBS)

  • by Maurizio De Luca, Scott Shikora, Dan Eisenberg, Luigi Angrisani, Chetan Parmar, Aayed Alqahtani, Ali Aminian, Edo Aarts, Wendy Brown, Ricardo V. Cohen, Nicola Di Lorenzo, Silvia L. Faria, Kasey P. S. Goodpaster, Ashraf Haddad, Miguel Herrera, Raul Rosenthal, Jacques Himpens, Angelo Iossa, Mohammad Kermansaravi, Lilian Kow, Marina Kurian, Sonja Chiappetta, Teresa LaMasters, Kamal Mahawar, Giovanni Merola, Abdelrahman Nimeri, Mary O’Kane, Pavlos Papasavas, Giacomo Piatto, Jaime Ponce, Gerhard Prager, Janey S. A. Pratt, Ann M. Rogers, Paulina Salminen, Kimberley E. Steele, Michel Suter, Salvatore Tolone, Antonio Vitiello, Marco Zappa, Shanu N. Kothari

  • September 25, 2024

Related Content

Postop Pain Differs by Vitamin D Status

Patients with preoperative vitamin D deficiency had higher postoperative pain scores and opioid use after mastectomy, including more than triple the odds of moderate to severe pain within 24 hours of surgery.

Retatrutide Shows 28% Weight Loss in Phase 3 Trial

Nearly half of participants receiving the highest dose achieved at least 30% body weight reduction.

Excluded-stomach Perforation after Roux-en-Y and One-anastomosis Gastric Bypass: A Systematic Review with Video-illustrated Case Report