Who Qualifies for Weight-Loss Surgery? A Patient's Guide to the 2022 ASMBS/IFSO Guidelines

Table of Contents

• Key Points
• Background: Why the Old Guidelines Needed Updating
• How the New Recommendations Were Developed
• BMI Criteria for Surgery
• Special BMI Thresholds for Asian Populations
• Age Considerations: Older Adults and Young Patients
• Surgery as a Bridge to Other Treatments
• Surgery in High-Risk Patients
• What This Means for Patients
• Limitations and Uncertainties
• Recommendations for Patients
• Frequently Asked Questions
• Source Information

Key Points

• The new guidelines recommend metabolic and bariatric surgery for people with a BMI of 35 kg/m² or higher, even without related health conditions.
• Surgery should be considered for people with a BMI of 30 to 34.9 kg/m² who have a metabolic disease such as type 2 diabetes.
• For Asian populations, clinical obesity is defined at a BMI of 25 to 27.5 kg/m², and surgery should be offered at 27.5 kg/m² or higher.
• The risk of death around the time of surgery is very low, ranging between 0.03% and 0.2%.
• Carefully selected children and adolescents may be considered for surgery; there is no evidence to support an age limit for older adults.

Background: Why the Old Guidelines Needed Updating

Thirty years ago, the National Institutes of Health (NIH) held a consensus conference and published a statement on gastrointestinal surgery for severe obesity. That 1991 statement reflected the medical knowledge available at the time. It recommended that nonsurgical programs should be the first treatment for severe obesity. It also stated that patients should be carefully selected for surgery after evaluation by a multidisciplinary team, and that lifelong medical monitoring should continue after surgery.

For three decades, health care providers, hospitals, and insurance companies used the 1991 NIH statement as the standard for deciding who could have bariatric surgery. The threshold was a BMI of 40 kg/m² or higher, or a BMI of 35 kg/m² or higher with obesity-related health conditions.

Since 1991, hundreds of studies have been published on the worldwide obesity epidemic and on the global experience with metabolic and bariatric surgery (MBS). These studies have greatly improved the understanding of obesity and its treatment. Obesity is now recognized as a chronic disease. It is associated with a chronic low-grade inflammatory state and immune dysfunction. Researchers suspect that prolonged inflammation disrupts the body's normal balancing mechanisms. This disruption leads to the metabolic disorders commonly associated with obesity. The exact pathways involve cytokine production, adipokines (signaling proteins made by fat tissue), hormones, and acute-phase reactants (proteins that rise during inflammation), but these pathways are not fully understood.

Long-term studies have proven that MBS is an effective and lasting treatment for severe obesity and its related conditions. Studies published in the decades after the 1991 statement consistently showed that MBS produces better weight loss than nonsurgical treatments. After surgery, multiple studies reported significant improvement in metabolic disease and a decrease in overall death rates. These findings further support the importance of this treatment approach.

At the same time, researchers have studied the safety of bariatric surgery extensively. The risk of death around the time of surgery is very low, ranging between 0.03% and 0.2%. As a result, MBS has become one of the most commonly performed operations in general surgery.

The operations themselves have evolved. Older operations have been replaced with safer and more effective ones. The 1991 NIH statement described vertical banded gastroplasty (VBG) and Roux-en-Y gastric bypass (RYGB) as the dominant procedures at that time. Today, the dominant procedures are sleeve gastrectomy and RYGB. Together, these two operations account for approximately 90% of all bariatric operations performed worldwide. Both have well-studied mid-term and long-term outcomes.

Other operations still performed include adjustable gastric banding (AGB), biliopancreatic diversion with duodenal switch, and one-anastomosis gastric bypass. VBG is now of historical interest only and is no longer performed. The popularity of adjustable gastric banding has decreased significantly over the past decade. MBS is now preferably performed using minimally invasive surgical approaches, either laparoscopic or robotic-assisted.

Because of these significant advances, the leadership of the American Society for Metabolic and Bariatric Surgery (ASMBS) convened. The International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) also convened to produce this joint statement. The statement reviews the current scientific information on metabolic and bariatric surgery and its indications.

How the New Recommendations Were Developed

The ASMBS and IFSO brought together a panel of experts from multiple countries, including the United States, the Netherlands, Italy, Brazil, Jordan, Belgium, Australia, the United Kingdom, and Switzerland. The panel reviewed the available scientific evidence on obesity, its management, and metabolic and bariatric surgery. The group then produced a joint statement on the current indications for MBS. The statement was received on August 4, 2022, and accepted on August 5, 2022.

The recommendations draw on randomized controlled trials (RCTs), meta-analyses, and observational studies. A randomized controlled trial assigns patients by chance to different treatments, which makes it the strongest type of study for comparing treatments. A meta-analysis combines results from multiple studies. An observational study follows patients without assigning their treatment.

BMI Criteria for Surgery

BMI remains the most practical and widely used way to identify and classify patients with overweight or obesity. However, the panel acknowledges that BMI has limitations. It does not accurately predict future health risk for every patient. Even so, MBS is currently the most effective evidence-based treatment for obesity across all BMI classes.

BMI 30 to 34.9 kg/m² (Class I obesity). Class I obesity is a well-defined disease. It causes or worsens multiple medical and psychological conditions. It decreases longevity and impairs quality of life. Prospective and large retrospective studies support considering MBS as a treatment option for patients with class I obesity. This applies to patients who do not achieve substantial or lasting weight loss, or who do not improve their related conditions, with nonsurgical methods.

Early findings prompted international diabetes organizations to publish a joint statement. That statement supported considering MBS for patients with a BMI under 35 kg/m² who have type 2 diabetes (T2D). Aminian and colleagues summarized the available data from randomized controlled trials, meta-analyses, and observational studies that also included individuals with a BMI under 35 kg/m². These data consistently demonstrate the weight loss and metabolic benefits of MBS in individuals with class I obesity.

Nouh and colleagues reported on more than 500 consecutive patients with a BMI under 35 kg/m² who had MBS. These patients demonstrated significant weight loss at 5 years. They also showed improvement or remission of diabetes, hypertension, and dyslipidemia (abnormal cholesterol and fat levels in the blood).

In a cohort study of more than 1,000 patients, MBS in individuals with a BMI under 35 kg/m² produced high rates of remission of related conditions. These patients were also more likely than patients with a BMI of 35 kg/m² or higher to achieve a BMI below 25 kg/m² after surgery.

Ikramuddin and colleagues, and Schauer and colleagues, demonstrated superior diabetes improvement and weight loss following MBS. Their randomized controlled trials included a subset of patients with a BMI under 35 kg/m². A 3-arm randomized controlled trial, in which 43% of subjects had class I obesity, demonstrated that MBS is superior to lifestyle intervention for remission of type 2 diabetes 3 years after surgery.

Randomized trials designed specifically to study the population with a BMI under 35 kg/m² also demonstrate significant benefits of MBS in individuals with class I obesity compared with other treatments. O'Brien and colleagues conducted a randomized controlled trial of 80 patients with a BMI of 30 to 35 kg/m². Patients were assigned to nonsurgical treatment or MBS. The patients who underwent MBS had superior long-term weight reduction and improvement of metabolic disease.

A short-term follow-up randomized trial examined patients with type 2 diabetes. It demonstrated significantly improved remission of diabetes and weight loss in the individuals who underwent MBS compared with medical weight management. In another study of 51 patients with class I obesity and diabetes, patients were randomized to either medical therapy or medical therapy plus MBS. The group that underwent surgery had superior diabetes control up to 2 years after the operation.

Medical weight loss is considered to have greater durability in individuals with a BMI under 35 kg/m² than in individuals with a BMI of 35 kg/m² or higher. For this reason, the panel recommends that a trial of nonsurgical therapy be attempted before considering surgical treatment. However, some patients do not respond to nonsurgical treatment. If attempts to treat obesity and related conditions have not been effective, MBS should be considered for suitable individuals with class I obesity.

The related conditions listed by the panel include type 2 diabetes, hypertension, dyslipidemia, obstructive sleep apnea, and cardiovascular disease. Cardiovascular disease includes coronary artery disease, heart failure, and atrial fibrillation. The panel also listed asthma, fatty liver disease and nonalcoholic steatohepatitis, chronic kidney disease, and polycystic ovarian syndrome. The panel also listed infertility, gastroesophageal reflux disease, pseudotumor cerebri (raised pressure inside the skull), and bone and joint diseases.

BMI 35 kg/m² or higher. High-quality scientific data support the safety, effectiveness, and cost-effectiveness of MBS in improving survival and quality of life in patients with a BMI of 35 kg/m² or higher. For this reason, MBS should be strongly recommended in these patients, regardless of whether they have evident obesity-related conditions.

Current nonsurgical treatment options for patients with a BMI of 35 kg/m² or higher are ineffective at achieving the substantial and sustained weight reduction needed to significantly improve general health. Several factors threaten the general health of individuals with moderate to severe obesity, even when no obesity-related condition has been diagnosed. These factors include physical problems related to excess body weight and undiagnosed obesity-related conditions. These factors also include the risk of developing obesity-related conditions in the future. These factors also include impaired quality of life related to the physical and mental consequences of obesity. Therefore, MBS is recommended in this population.

Special BMI Thresholds for Asian Populations

The World Health Organization defines the terms overweight and obesity based on BMI thresholds. In its 1991 consensus statement, the NIH noted that the risk of illness linked with obesity is proportional to the degree of overweight. However, BMI does not account for a person's sex, age, ethnicity, or fat distribution. BMI is recognized as only an approximation of body fat.

Consider two patients with different BMIs. One patient has a BMI of 30 kg/m² with visceral and ectopic fat accumulation (fat stored around organs and in unusual locations) and related metabolic and cardiovascular disease. The other patient has a BMI of 40 kg/m² with fat stored mainly in the lower extremities. The health risk of the first patient would be significantly higher than that of the second patient.

In the Asian population, the prevalence of diabetes and cardiovascular disease is higher at a lower BMI than in the non-Asian population. For this reason, BMI risk zones should be adjusted for this population. Clinical obesity should be defined at a BMI threshold of 25 to 27.5 kg/m² in Asian populations. Therefore, in certain populations, access to MBS should not be denied solely based on traditional BMI thresholds.

Age Considerations: Older Adults and Young Patients

Older adults. Over the past few decades, surgery has been performed successfully in increasingly older patients, including individuals over 70 years of age. This trend coincided with the demonstrated safety of MBS. In patients in their seventies, MBS is associated with slightly higher rates of postoperative complications compared with a younger population. Even so, it still provides substantial benefits of weight loss and remission of related disease.

The presence of obesity-related disease and the choice of operation are more predictive of 30-day adverse outcomes than age alone. The question of whether there should be an upper age limit for surgery is complex, just as it is for other operations. The physiologic changes that occur with aging may affect how well MBS works, the incidence of postoperative complications, and the ability of older patients to recover from surgery. However, factors other than age appear to play an important role. These factors include frailty, cognitive capacity, smoking status, and end-organ function.

Frailty, rather than age alone, is independently associated with higher rates of postoperative complications following MBS. When considering MBS in older patients, the risk of surgery should be weighed against the risk of illness from obesity-related diseases. There is no evidence to support an age limit on patients seeking MBS. However, careful selection that includes assessment of frailty is recommended.

Children and adolescents. Children and adolescents with obesity carry the burden of the disease and its related conditions into adulthood. This increases the individual risk for premature death and for complications from obesity-related conditions.

MBS is safe in the population younger than 18 years. It produces durable weight loss and improvement in related conditions. Adolescents with severe obesity who undergo RYGB have significantly greater weight loss and improvement of cardiovascular conditions compared with adolescents who receive medical management. Improvement in hypertension and dyslipidemia has been demonstrated up to 8 years after surgery.

Additional studies from the prospective Teen-Longitudinal Assessment of Bariatric Surgery database (Teen-LABS) demonstrated significant weight loss and durable improvement in cardiovascular risk factors and type 2 diabetes in adolescents undergoing MBS. Data also suggest that the benefits of RYGB on type 2 diabetes and hypertension are greater in adolescents than in adults. Prospective data show durable weight loss and maintained remission of related conditions in patients as young as 5 years old.

The American Academy of Pediatrics and the ASMBS recommend consideration of MBS in children and adolescents with a BMI above 120% of the 95th percentile (class II obesity). The American Academy of Pediatrics and the ASMBS also recommend consideration of MBS in children and adolescents with a major related condition. They also recommend consideration for those with a BMI above 140% of the 95th percentile (class III obesity).

MBS does not negatively impact pubertal development or linear growth. Therefore, a specific Tanner stage (a measure of physical development) and bone age should not be considered a requirement for surgery. Increasingly, syndromic obesity, developmental delay, autism spectrum, or a history of trauma is not considered a contraindication to MBS in adolescents.

Surgery as a Bridge to Other Treatments

Joint replacement. Poorer outcomes after total joint arthroplasty (joint replacement surgery) have been associated with obesity. As a result, some orthopedic surgical societies discourage hip and knee replacement in individuals with a BMI above 40 kg/m². Performing orthopedic surgery in individuals with severe obesity is technically challenging. In addition, patients with obesity undergoing joint arthroplasty are at increased risk of hospital readmission. These patients are also at increased risk of surgical complications, such as wound infection and deep vein thrombosis (blood clots in deep veins).

There are reports suggesting that MBS may be effective as a bridge to total joint arthroplasty in individuals with class II or class III obesity. In these reports, MBS was performed at least 2 years prior to joint surgery. A study of veterans with osteoarthritis demonstrated that an average of 35 months elapsed between MBS and joint arthroplasty or lumbar spine surgery in patients with known osteoarthritis.

MBS prior to total knee and hip arthroplasty has been shown to decrease operative time, hospital length of stay, and early postoperative complications. Long-term joint-related complication rates were not significantly different.

A randomized clinical trial studied 82 patients with obesity and osteoarthritis. Forty-one patients were randomized to adjustable gastric banding 12 months prior to total knee arthroplasty (TKA). Forty-one patients were randomized to receive usual nonoperative weight management prior to TKA. In a median follow-up of 2 years after TKA, 14.6% of patients in the MBS group experienced the primary outcome of composite complications. This compared with 36.6% in the control (non-MBS) group, a difference of 22.0% that was statistically significant (P = .02).

Interestingly, 29.3% of subjects in the MBS group declined TKA because their symptoms improved following weight loss. Only 4.9% of the control group declined TKA.

Abdominal wall hernia repair. Obesity is a risk factor for the development of ventral hernia (a bulge through the abdominal wall). Obesity increases the risk for impaired wound healing, local and systemic infections, and other complications following hernia repair. It also increases the risk for hernia recurrence.

Abdominal wall hernias in the population with obesity tend to be larger, in part because of a larger volume of subcutaneous soft tissue. This adds to the complexity of repair in these patients. The timing of MBS relative to hernia repair remains controversial. However, evidence suggests that patients with a large, chronic abdominal wall hernia may benefit from significant weight loss initially as a staged procedure before definitive hernia repair.

In patients with severe obesity and an abdominal wall hernia requiring elective repair, MBS should be considered first. The goal is to induce significant weight loss. This can reduce the rate of complications associated with hernia repair and increase the durability of the repair.

Organ transplantation. Class III obesity is associated with end-stage organ disease. It may also limit a patient's access to transplantation, since obesity is a relative contraindication for solid organ transplantation and poses specific technical challenges during surgery. Conversely, MBS may be overlooked as an option in patients with severe end-stage organ disease.

MBS has been described in patients with end-stage organ disease as a way to improve their candidacy for transplantation. Patients with end-stage organ disease can achieve meaningful weight loss and improve their eligibility to receive an organ transplant.

Studies suggest that more than 50% of patients with end-stage renal disease (ESRD) and morbid obesity are able to be listed for kidney transplant within 5 years after MBS. Similarly, MBS is shown to be safe and effective as a bridge to liver transplantation in selected patients who would otherwise be ineligible.

Heart transplant candidacy can also be improved by MBS. Reports in some patients demonstrate significant improvement in left ventricular ejection fraction (a measure of how well the heart pumps) after surgery. The improvement was to the point that transplantation was no longer required.

MBS has been shown to be safe and effective in patients with heart failure and a left ventricular assist device (LVAD), a mechanical pump that helps the heart circulate blood. McElderry and colleagues studied 2,798 patients who underwent LVAD implantation. A history of prior MBS was associated with a 3-fold higher probability of heart transplantation during follow-up, compared with patients who did not have MBS. In addition, limited data suggest that patients with obesity and end-stage lung disease may lose sufficient weight after MBS to achieve listing for transplantation.

Surgery in High-Risk Patients

BMI above 60 kg/m². There is no consensus concerning the best procedure for individuals with an especially high BMI. However, the efficacy and safety of MBS have been demonstrated in this population. In general, mortality risk increases with increasing BMI. A BMI above 50 kg/m² has been implicated in increasing surgical risk in older studies.

Individuals with a BMI above 60 kg/m² are considered to be at especially high risk for surgery. These patients have a greater burden of obesity-associated disease and more challenging surgical anatomy. Some studies show that this leads to longer operative times, higher rates of perioperative illness, and longer hospital stays.

Other studies, however, failed to demonstrate a significant difference in perioperative complications, length of stay, 30-day mortality, or long-term outcomes after MBS. This was found when individuals with a BMI above 60 kg/m² were compared with those with a BMI below 60 kg/m². Furthermore, studies have shown that MBS can be performed safely in patients with a BMI above 70 kg/m². Therefore, MBS should be considered as a preferred method to achieve clinically significant weight loss in patients with extreme BMI.

Cirrhosis. Obesity is a significant risk factor for nonalcoholic fatty liver disease (NAFLD). Obesity is also a significant risk factor for nonalcoholic steatohepatitis (NASH, a more severe form of fatty liver disease with inflammation). Obesity is also a significant risk factor for the cirrhosis that can follow. At the same time, obesity conveys a 3-fold increase in the risk of liver decompensation in patients with known cirrhosis.

In addition to inducing significant and durable weight loss, MBS has been associated with histologic improvement of NASH and regression of fibrosis in early cases. This leads to a reduced risk of hepatocellular carcinoma (liver cancer). Furthermore, MBS is associated with an 88% risk reduction of progression of NASH to cirrhosis.

The patient with obesity and compensated cirrhosis is at higher risk for perioperative death following MBS. However, the risk remains small, at less than 1%, and the benefits are significant. There is a shortage of data on surgical outcomes in patients with clinically significant portal hypertension (high blood pressure in the liver's blood vessels). Careful patient selection and consideration of the choice of surgical procedure are important to ensure the best outcomes.

Heart failure. Increasing data suggest that MBS can be a useful addition to treatment in patients with obesity and heart failure. This applies before heart transplantation or placement of a left ventricular assist device. MBS is performed with low rates of illness and death in these patients. The resulting improvement in obesity and associated conditions improves overall health. It can also reduce the future risk associated with cardiac therapies.

Furthermore, limited studies have shown that MBS in individuals with heart failure was associated with a significant improvement of left ventricular ejection fraction. MBS in individuals with heart failure was also associated with improvement of functional capacity. MBS in individuals with heart failure was also associated with higher chances for receiving heart transplantation.

What This Means for Patients

The new guidelines represent a major shift from the 1991 NIH criteria. The most important changes are summarized below.

• MBS is recommended for individuals with a BMI of 35 kg/m² or higher, regardless of whether they have related health conditions, and regardless of how severe those conditions are.
• MBS should be considered for individuals with metabolic disease and a BMI of 30 to 34.9 kg/m².
• BMI thresholds should be adjusted in Asian populations. A BMI of 25 kg/m² or higher suggests clinical obesity in this group, and individuals with a BMI of 27.5 kg/m² or higher should be offered MBS.
• Long-term results of MBS consistently demonstrate safety and efficacy.
• Appropriately selected children and adolescents should be considered for MBS.

For patients, these changes mean that more people may qualify for weight-loss surgery than under the old rules. A patient with a BMI of 35 or higher no longer needs to have a diagnosed related condition to be recommended for surgery. A patient with a BMI of 30 to 34.9 and a metabolic disease such as type 2 diabetes may now be considered a candidate. Patients of Asian descent may qualify at even lower BMI levels.

The guidelines also address patients who were previously told they were not candidates. This includes older adults, adolescents, patients with extreme BMI above 60 kg/m², patients with cirrhosis, patients with heart failure, and patients who need joint replacement or organ transplantation. For each of these groups, the panel found evidence that MBS can be safe and beneficial when patients are carefully selected.

Limitations and Uncertainties

The panel acknowledges several limitations and areas of uncertainty.

• BMI does not accurately risk-stratify every patient. It does not account for sex, age, ethnicity, or fat distribution.
• There is no consensus on the best procedure for individuals with an especially high BMI.
• The timing of MBS relative to hernia repair remains controversial.
• There is a shortage of data on surgical outcomes in patients with clinically significant portal hypertension.
• Data on MBS in patients with end-stage lung disease are limited.
• Some studies of patients with a BMI above 60 kg/m² found higher risks, while others found no significant difference in complications or mortality.
• The evidence for MBS as a bridge to joint replacement and transplantation comes from observational studies and a small number of randomized trials. The evidence does not come from large randomized trials in every patient group.

These uncertainties mean that treatment decisions should be made individually. Patients should discuss the risks and benefits with a multidisciplinary team.

Recommendations for Patients

Based on this joint statement, patients can take the following steps.

1. Ask your health care provider to calculate your BMI and discuss whether you meet the new criteria for metabolic and bariatric surgery.
2. If you have a BMI of 35 kg/m² or higher, you may be recommended for surgery regardless of whether you have other health conditions.
3. If you have a BMI of 30 to 34.9 kg/m² and a metabolic disease such as type 2 diabetes, ask whether MBS should be considered for you.
4. If you are of Asian descent, ask about adjusted BMI thresholds, since clinical obesity may be defined at a BMI of 25 to 27.5 kg/m² for you.
5. If you have been told you are not a candidate because of your age, your weight, or another condition, ask for a reassessment based on these updated guidelines.
6. If you are considering joint replacement, hernia repair, or organ transplantation, ask whether weight-loss surgery before the procedure could improve your outcomes.
7. Seek evaluation by a multidisciplinary team that can assess your individual risks, including frailty, cognitive capacity, smoking status, and organ function.
8. Plan for lifelong medical monitoring after surgery, as recommended in both the 1991 statement and the new guidelines.

Frequently Asked Questions

Who can now qualify for weight-loss surgery under the new guidelines?

The new guidelines recommend surgery for people with a BMI of 35 kg/m² or higher, even if they have no related health conditions. People with a BMI of 30 to 34.9 kg/m² and a metabolic disease such as type 2 diabetes may also be considered. Asian populations have lower BMI thresholds.

What BMI do I need to have surgery if I have type 2 diabetes?

If you have type 2 diabetes, surgery should be considered at a BMI of 30 to 34.9 kg/m². The panel recommends trying nonsurgical treatment first, but if that has not worked, surgery may be an option. Your doctor can help assess whether you meet the criteria.

I am of Asian descent. Do different BMI rules apply to me?

Yes. The guidelines say clinical obesity should be defined at a BMI of 25 to 27.5 kg/m² in Asian populations, because diabetes and cardiovascular disease occur at lower BMI levels in this group. Surgery should be offered at a BMI of 27.5 kg/m² or higher. Ask your doctor about adjusted thresholds.

Is weight-loss surgery safe? What is the risk of dying around the time of surgery?

The risk of death around the time of surgery is very low, ranging between 0.03% and 0.2%. The operations have evolved, and the most common procedures today are sleeve gastrectomy and gastric bypass. Surgery is usually performed using minimally invasive approaches. Your individual risks should be discussed with a multidisciplinary team.

I was told I was not a candidate because of my age. Could I be reconsidered?

Possibly. The guidelines state there is no evidence to support an age limit for surgery. Older adults, including those over 70, can benefit, though they may have slightly higher rates of complications. Frailty, rather than age alone, is linked to higher complication rates. Ask for a reassessment that includes an evaluation of frailty.

Can children and teenagers have weight-loss surgery?

Yes, for carefully selected young people. The guidelines support considering surgery for children and adolescents with a BMI above 120% of the 95th percentile (class II obesity) or above 140% (class III obesity), or with a major related condition. Surgery does not negatively impact puberty or growth. A multidisciplinary team should assess each patient.

What should I do if I want to find out if I qualify for surgery?

Ask your health care provider to calculate your BMI and discuss whether you meet the new criteria. If you have a BMI of 35 or higher, you may be recommended for surgery regardless of other conditions. If you have a BMI of 30 to 34.9 with a metabolic disease, ask whether surgery should be considered. Seek evaluation by a multidisciplinary team.

I was told I don't qualify for weight-loss surgery because my BMI is 33 and I only have type 2 diabetes — should I get a second opinion?

Yes, this is a reasonable situation to seek one. Under the updated international recommendations, surgery should be considered for patients with a BMI of 30 to 34.9 kg/m² who have a metabolic disease such as type 2 diabetes, after a trial of nonsurgical therapy. Patients of Asian descent may qualify at even lower BMI levels. If you were previously told you were not a candidate because of your weight or another condition, ask for a reassessment based on these updated guidelines. Diagnostic Detectives Network provides independent expert second opinions.

Source Information

Original article title: Indications for Metabolic and Bariatric Surgery

Authors: Dan Eisenberg, M.D.; Scott A. Shikora, M.D.; Edo Aarts, M.D., Ph.D.; Ali Aminian, M.D.; Luigi Angrisani, M.D.; Ricardo V. Cohen, M.D., Ph.D.; Maurizio De Luca, M.D.; Silvia L. Faria, Ph.D.; Kasey P. S. Goodpaster, Ph.D.; Ashraf Haddad, M.D.; Jacques M. Himpens, M.D., Ph.D.; Lilian Kow, B.M.B.S., Ph.D.; Marina Kurian, M.D.; Ken Loi, M.B.B.S., B.Sc. (Med); Kamal Mahawar, M.B.B.S., M.Sc.; Abdelrahman Nimeri, M.D., M.B.B.Ch.; Mary O'Kane, M.Sc., R.D.; Pavlos K. Papasavas, M.D.; Jaime Ponce, M.D.; Janey S. A. Pratt, M.D.; Ann M. Rogers, M.D.; Kimberley E. Steele, M.D., Ph.D.; Michel Suter, M.D.; Shanu N. Kothari, M.D.

Publication: Surgery for Obesity and Related Diseases, 2022, volume 18, pages 1345–1356. Received August 4, 2022; accepted August 5, 2022. DOI: 10.1016/j.soard.2022.08.013. Published by Elsevier on behalf of the American Society for Metabolic & Bariatric Surgery (ASMBS) and Springer Nature on behalf of the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO). This is an open-access article under the CC BY-NC-ND license.

This patient-friendly article is based on peer-reviewed research.