What do the new weight loss surgery guidelines mean?

John Scott, MD

Bariatric Surgery

For the first time in more than 30 years, the guidelines for weight loss surgery have been updated. The American Society for Metabolic and Bariatric Surgery (ASMBS) and International Federation for Surgery of Obesity and Metabolic Disease (IFSO) recently released new guidelines to help patients and referring physicians determine which patients get the highest benefit from metabolic surgery with the lowest amount of risk.

Bariatric surgeon John Scott, MD, explained what led to these new guidelines and what they mean for patients who are considering weight loss surgery.

Why did the ASMBS change its weight loss surgery guidelines?

Previous guidelines, called the National Institutes of Health 1991 Consensus Guidelines on Bariatric Surgery, were based on outdated information collected in the 1980s. These rules for bariatric surgery helped standardize the practice of bariatric surgery in the 1990s. However, new advances in minimally invasive surgery techniques such as laparoscopic and robotic surgery, as well as standardization in accreditation of bariatric programs and surgeon training, have lowered complication rates and increased success rates. 

“There has been an explosion in research in our field and this has increased our understanding of how these surgeries work and help people overcome the disease of obesity,” Dr. Scott said.  “The 1991 guidelines no longer make sense in today’s surgical world, so the leaders of the two most important bariatric and metabolic surgery organizations led a group of experts to look at the most up-to-date evidence to design a new set of guidelines. These new guidelines are the result of years of hard work to make sure our patients have the best information about surgery and can make informed decisions about their future.”

How does this change benefit patients?

The biggest change for patients is the lowering of barriers to get to surgery. In the old system, weight and body mass index (BMI) became barriers to accessing surgical treatment for the disease of obesity. 

For example, in the old system, if you had a BMI of 39 but didn’t have any medical conditions related to your weight (like diabetes), you were not a candidate for surgery, even though you had “severe obesity.”  Under the new guidelines, metabolic surgery is recommended for patients with a BMI as low as 35, even if they don’t have medical conditions related to weight. 

In addition, if you have type 2 diabetes, the new guidelines recommend that patients with a BMI of just 30 (or 27 if you are of Asian descent) be considered for surgical therapy because many patients go into remission after surgery. 

Is weight loss surgery now recommended for children and teens?

Weight loss surgery is now recommended for children and adolescents. 

“It is well known that children and adolescents that have the disease of obesity carry that burden into adulthood and are on a pathway to highest rates of diabetes, high blood pressure, sleep apnea, and early death,” Dr. Scott said. “These medical issues are like giant anchors tied to the body and the longer someone has these conditions, the more damage they can cause over time. New evidence demonstrates that if we can eliminate the obesity early, we can reverse many of these medical issues and prevent the long-term complications an early death that is associated with them.”

Does insurance cover weight loss surgery for people who meet these new guidelines?

Insurance plans are evaluating the changes in the guidelines. Some have agreed to accept these changes, and some have yet to do so. For patients who have insurance with providers that have not broadly recognized the new guidelines, each request for coverage will have to be tackled on a case-by-case basis.  

“We would encourage patients, if they meet the new criteria for surgery and are denied treatment, to appeal those decisions and supply their insurance provider with these new guidelines,” Dr. Scott said. “There are resources from patient-advocacy groups to help in these cases. With time, the insurance providers will adjust their criteria to reflect the new guidelines.”