Updated NIH guideline makes more people eligible for bariatric, metabolic surgery
Click Here to Manage Email Alerts
Updates to the 1991 NIH statement on gastrointestinal surgery for severe obesity include recommendations for metabolic and bariatric surgery, BMI threshold adjustments and consideration of surgery for children and adolescents.
“Since the publication of the NIH Consensus Statement on Gastrointestinal Surgery for Severe Obesity in 1991, there was a need to critically analyze the many studies, including randomized clinical trials, that have significantly increased our understanding of obesity and metabolic and bariatric surgery,” Dan Eisenberg, MD, MS, FACS, FASMBS, associate professor of surgery in the department of surgery at Stanford School of Medicine and VA Palo Alto Health Care System, California, told Healio. “An increasing global clinical experience over the past 30 years, along with results of long-term studies, have proven metabolic and bariatric surgery to be a safe, effective and durable treatment modality.”
The updates, published in Surgery for Obesity and Related Diseases, include the following:
- Metabolic and bariatric surgery should be recommended for individuals with a BMI of 35 kg/m2 or higher, regardless of the presence, absence or severity of any comorbidities.
- Metabolic and bariatric surgery should be considered for individuals with metabolic disease and a BMI of 30 kg/m2 to 34.9 kg/m2.
- BMI thresholds should be adjusted for Asian populations for whom a BMI of 25 kg/m2 or higher suggests clinical obesity. Individuals with a BMI of 27.5 kg/m2 or higher should be offered metabolic and bariatric surgery.
- Long-term study results of metabolic and bariatric surgery have consistent safety and efficacy data.
- Appropriately selected children and adolescents should also be considered for metabolic and bariatric surgery.
“The new guidelines recommend eliminating the requirement for surgery that all but the heaviest individuals must have a medical comorbidity resulting from obesity,” Eisenberg said. “Individuals who would otherwise be missed or denied metabolic and bariatric surgery in the past, will now be recognized as appropriate candidates for surgery, thus improving access to this most effective treatment.”
Metabolic and bariatric surgery is recommended for people with type 2 diabetes and a BMI of 30 kg/m2 or higher as a highly effective treatment and should be considered for those with a BMI of 30 kg/m2 to 34.9 kg/m2 who do not achieve substantial or durable weight loss or comorbidity improvement using nonsurgical methods, Eisenberg said.
“Continued research in the form of large, well-designed, prospective and randomized studies, collecting long-term data to better understand obesity and its life-long treatment [are needed],” Eisenberg said. “In addition, research will be needed to elucidate the role of multimodal therapy in the management of this chronic disease.”
For more information:
Dan Eisenberg, MD, MS, FACS, FASMBS, can be reached at de1@stanford.edu.
Collapse
Click Here to Manage Email Alerts