New recommendations extend eligibility criteria for bariatric surgery

A bariatric surgeon at the Ohio State Wexner Medical Center is advocating for a new set of clinical guidelines that would extend eligibility for weight loss surgery to thousands more patients struggling with their weight.

Stacy Brethauer, MD, a surgeon at the Wexner Medical Center’s Bariatric Surgery Center of Excellence, acknowledged the American Society for Metabolic and Bariatric Surgery’s latest publish as a step in the right direction for patients who are obese but might not meet current criteria for bariatric surgery. Right now those criteria, which are three decades old, are “arbitrarily” based on a patient’s body mass index and don’t account for other confounding factors.

“Too many see obesity as a problem of willpower, and it’s simply not,” Brethauer, a co-author of the new guidelines, said in a statement. “Patients must participate in their care by making healthy lifestyle changes, but the most effective treatment is often surgery, and that should be an option for patients who would benefit.”

He said that if two patients with uncontrolled diabetes were brought in for bariatric surgery—one with a BMI of 35 and the other with a BMI of 34—the first would qualify for surgery under current guidelines, but the second would be barred from that opportunity. 

“The patient who doesn’t get the operation, we know very well that their disease will progress and their lifespan will be shortened,” Brethauer said. “Continuing to increase their insulin requirements will not change the trajectory of the disease. Surgery does.”

He said multiple clinical studies have backed the idea that bariatric surgery can benefit patients even with lower BMIs. He said it’s up to physicians and insurers to adopt the new draft of standards, extending the possibility of surgery to more patients.