Bariatric Surgery Indications in the 2020s

Based on the substantial body of evidence supporting the safety, efficacy, and durability of metabolic and bariatric surgery (MBS), a new joint statement from the American Society for Metabolic and Bariatric Surgeons (ASMBS) and IFSO was issued in 2022 to expand the outdated surgical indications originally outlined in the 1991 National Institute of Health (NIH) Consensus Conference. Specifically, surgery should be considered for people with a body mass index (BMI) ≥ 30 kg/m2 and concomitant metabolic disease such as type 2 diabetes mellitus (T2DM) if a trial of medical therapy is unsuccessful, and in people with BMI ≥ 35 kg/m2 regardless of the presence or absence of comorbid conditions. Extremes of age was also addressed, with recommendations for MBS in pediatric patients with BMI ≥ 120% of the 95th percentile and a major comorbidity, or a BMI ≥ 140% of the 95th percentile. Additionally, there is no upper patient-age limit provided the patient is an otherwise appropriate surgical candidate with an accurate assessment of frailty. In patients needing other specialty surgeries such as joint arthroplasty, abdominal wall reconstruction, or organ transplant, MBS should be considered as an effective bridging therapy to improve access, eligibility and specialty surgery outcomes. Preoperative multidisciplinary evaluation and preparation remain paramount to ensure appropriate patient selection and outcome within this broadened potential patient population.