Beyond the BMI: the search for better guidelines for bariatric surgery

Area of Science:

• Bariatric surgery
• Obesity management
• Metabolic disease

Background:

• Current guidelines use a body mass index (BMI) of 35 or greater as a primary requirement for bariatric surgery access.
• This BMI threshold is incorporated into policies by Medicare, Medicaid, and most private insurers.
• The BMI index has limitations in accurately reflecting adiposity, potentially leading to unfair discrimination based on gender, race, age, fitness, and body fat composition.

Purpose of the Study:

• To evaluate the appropriateness of using BMI >= 35 as the main prerequisite for bariatric surgery.
• To advocate for new guidelines considering emerging evidence on bariatric surgery's effectiveness in managing comorbidities.

Main Methods:

• Review of current bariatric surgery access criteria.
• Analysis of the limitations of BMI as a sole indicator of obesity and surgical candidacy.
• Examination of evidence regarding bariatric surgery's impact on comorbidities like type 2 diabetes.

Main Results:

• The BMI of >= 35 is deemed inappropriate due to its failure to account for adiposity distribution and its potential for discriminatory application.
• Emerging evidence indicates bariatric surgery can achieve significant and lasting remission of type 2 diabetes, even in patients with BMIs below 30.
• Current guidelines may exclude patients who could benefit from surgery and include those who may not require it based solely on BMI.

Conclusions:

• The reliance on BMI >= 35 for bariatric surgery access is no longer appropriate.
• New guidelines are necessary to ensure equitable access and optimize patient outcomes.
• Bariatric surgery shows potential for treating type 2 diabetes and other comorbidities, even in individuals with lower BMI values, necessitating a re-evaluation of eligibility criteria.