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Changing Guidelines for Metabolic Surgery: Now It's the Time!

Pedro Paulo Caravatto1, Tarissa Petry2, Ricardo Cohen2

  • 1The Center for Obesity and Diabetes - Oswaldo Cruz German Hospital, Rua Cincinato Braga, 37 5o. andar, São Paulo, SP, Brazil. pcaravatto@haoc.com.br.

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Summary

Current bariatric surgery guidelines, based on body mass index (BMI), are outdated. New criteria are needed to ensure patients, especially those with type 2 diabetes (T2DM) and lower BMIs, can access life-saving metabolic surgery.

Keywords:
Body mass indexIndication criteriaMetabolic surgeryType 2 diabetes

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Area of Science:

  • Metabolic and Bariatric Surgery
  • Obesity Medicine
  • Clinical Guidelines

Background:

  • Bariatric surgery guidelines established in 1991 rely exclusively on body mass index (BMI).
  • These criteria restrict surgical access to only severely obese individuals.
  • The evolution of bariatric procedures and evidence necessitates updated guidelines.

Purpose of the Study:

  • To highlight the limitations of current BMI-based criteria for bariatric surgery.
  • To advocate for the urgent development of new guidelines for metabolic surgery.
  • To ensure equitable access to life-saving surgical treatments.

Main Methods:

  • Review of historical bariatric surgery guidelines.
  • Analysis of current evidence from randomized controlled trials comparing surgical and clinical interventions for obesity.
  • Assessment of the utility of BMI as a sole criterion for surgical candidacy.

Main Results:

  • Body mass index (BMI) is an inadequate sole indicator for selecting optimal treatment for obesity.
  • Current guidelines may exclude patients who could benefit from bariatric surgery, particularly those with type 2 diabetes (T2DM) and lower BMIs.
  • Evidence supports the efficacy of contemporary bariatric procedures.

Conclusions:

  • Existing 1991 guidelines for bariatric surgery are insufficient due to advancements in surgical techniques and evidence.
  • New guidelines are critically needed to properly define indications, regulate, and reimburse metabolic surgery.
  • Updating guidelines will improve patient access to effective obesity treatments.