In October, the National Institutes of Health’s 31-year-old guidelines for weight loss surgery were revised. The new guidelines expand patient eligibility for weight loss surgery.
The recommendations from 1991 for considering bariatric or weight loss surgery were for people with body mass index (BMI) of at least 40. Those with BMIs of 35 or more with one obesity-related condition such as hypertension or heart disease were also candidates. The guidelines recommended against surgery for obese children and adolescents, even those with BMIs over 40.
The American Society for Metabolic and Bariatric Surgery (ASMBS) and the International Federation for Surgery of Obesity and Metabolic Disorders (IFSO), which represents 72 countries issued the new guidelines. They now recommend weight loss surgery for adults with a BMI over 35, whether or not they have health issues.
The new guidelines for weight loss surgery suggest weight loss surgery for children and adolescents BMIs of 30 to 34.9. This is critical because weight-related diseases are easier to reverse if treated in adolescence. The American Academy of Pediatrics (AAP) has already recommended that insurance companies cover bariatric surgery without age limits for coverage.
These recommendations are based on the safety of the procedures. Also, weight loss surgery has shown better success in improving health outcomes than nonsurgical methods in the last 30 years.
Other groups are also changing recommendations for weight loss surgery to improve the health of obese people. In 2016, 45 professional societies, including the American Diabetes Association, recommended that metabolic surgery be considered for patients with Type 2 diabetes and a BMI of 30 to 34.9 when hyperglycemia was inadequately controlled despite medication.
H2: Why Guidelines for Weight Loss Surgery are Important
The CDC reports that more than 42% of Americans are obese. Yet only 1 to 2 % of the world’s eligible patient population get weight loss surgery any year. This is in part because of the decades-old recommendations impacting decisions of insurers, policymakers, health care providers and patients.
It can be a matter of life and death.
More than 200 diseases are tied to excess weight.
Excess body fat raises the levels of LDL or “bad” cholesterol and triglycerides while also lowering the HDL or “good” cholesterol levels. In addition, obesity impedes the body’s ability to respond to insulin, raising blood sugar. As a result, obesity and a lack of exercise are responsible for about 1,000 American deaths daily. Obesity will soon overtake smoking as the leading preventable causes of death in the U.S.
Research shows that weight loss surgery can normalize blood pressure and cholesterol. Also, surgery improves cardiovascular function, emotional health and testosterone levels. Surgery can also reduce the risk of certain cancers and sleep apnea. In addition, weight loss surgery can provide relief from joint pain and result in remission for Type 2 diabetes.
Studies have found that 95% of teens who had Type 2 diabetes before surgery saw their diabetes resolve. Nearly 80% normalized their high blood pressure. Also, up to 8 years after surgery, studies found that many teens had lower rates of depression.
Changing Thinking about Obesity
It is time for Medicare, the insurance industry and the public to update their thinking about this life-saving surgery. Doing so will help make it available and affordable to so many who can benefit.
The recommendations have changed for weight loss surgery, so we should also change how we think about treating obesity. Decades of research show obesity is not an issue of willpower; biology determines obesity. Just like heart disease and other medical conditions, the impacts of obesity can be improved with surgery.
About the Author
Dr. Moses Shieh specializes in advanced laparoscopic, bariatric and general surgery. He is the founder of Surgical Healing Arts. Click here to register for a free seminar about the benefits of weight loss surgery.