New Bariatric Surgery Guidance Released by ASMBS and IFSO
While excess weight and obesity are some of the most researched topics in modern-day society, mainly due to the incredible rise in weight-related comorbidities, we do not often get the exciting news of new surgical guidance or suggestions from influential organizations. When they happen, it’s a big deal and something we should consider carefully. Just that happened last month when the American Society for Metabolic and Bariatric Surgery (ASMBS) and the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) released joint guidance intended to update federal guidelines since 1991. In your research of bariatric surgery, you’ve likely come across these older guidelines, which essentially state that patients with a BMI of 35 or over with one or more obesity-related comorbidities or patients with a BMI of 40 or over regardless of comorbidities may be eligible for bariatric surgery. While these guidelines have been in place for the best of three decades, they have also limited access to bariatric surgery for millions of patients suffering from excess weight-related conditions but with no qualifying BMI. How is this possible?
Ultimately, the reason for this is the inherent inaccuracy of the BMI calculation. The BMI was never intended to be used as a measure of obesity. The larger question is, what exactly is obesity? Arbitrary BMI levels very loosely define obesity – there’s little empirical evidence behind it.
What Exactly Does That Mean?
We have known since the BMI became the standard for bariatric surgery qualification, that some patients with higher BMIs do not have significant metabolic disorders. In contrast, other patients with relatively lower BMI have debilitating excess weight-related conditions. Yet the former would qualify for bariatric surgery while the latter, who seemingly need it more, would not. This is because the BMI does not consider certain factors, including body shape, gender, race and ethnicity, musculature, etc. We now know, for example, that waist size and the location of visceral fat accumulation are better predictors of obesity-related conditions than BMI alone.
The Significance of This Guidance
While this guidance is not legally binding and does not hold regulatory weight, it will likely be considered when federal agency guidelines are updated at some point in the future. This is important because these new suggestions represent the modern bariatric surgery landscape more than the old guidelines. First, the BMI thresholds have been reduced by five points. In other words, patients with a BMI of 30 or more with one or more obesity-related comorbidities should be considered for bariatric surgery, as should patients with a BMI of 35 or more, regardless of their comorbidities. Further, those of Asian descent should be considered for bariatric surgery at a relatively lower BMI of 27.5. This is because we know that, by and large, Asians are affected by weight-related comorbidities at lower BMIs than other races.
The suggestions for adolescent bariatric surgery have also been clarified. Surgery in children under 18 has been somewhat controversial, with concerns about growth and other developmental issues that may occur because of surgery. However, these updated suggestions have considered that in some cases, the benefits of bariatric surgery adequately address the risks associated with living with morbid obesity and outweigh the risks of surgery, even in younger patients.
What Happens Next?
The short answer is that we don’t know, but in the near future, not much. Government regulators and private insurance companies are typically slow to adopt new research, opting to be safe rather than sorry. However, the bariatric surgery landscape has changed dramatically over the past 30 years. When the old guidelines were introduced, open surgery was still the predominant form of intervention, and minimally invasive surgery was only in its infancy. Just factoring in the reduced risk of surgery with modern technology makes implementing new guidelines an urgent priority.
In the meantime, however, we can only wait to see how these suggestions are taken by the regulatory powers. Eventually, the likelihood is we will see some change. But for now, patients with a BMI of 35 or over should speak to a qualified weight loss program like ours to see what options they have in managing and improving their weight. If you have any questions about bariatric surgery or wish to speak to Dr. Higa about the viability of surgery for your circumstance, we encourage you to schedule a consultation after watching our online seminar.