Dr. Javier Acuna.
Bariatric and metabolic surgery.

For more than 30 years, the care guides for the management of
patients with obesity.

The 1991 NIH Consensus Statement has been used by providers, hospitals, and
insurers as a standard for selection criteria for bariatric surgery.(1) A
body mass index (BMI) of 40 kg/m2, or a BMI of 35 kg/m2 with comorbidities, is a
threshold for surgery that applies universally.

Since then, hundreds of studies have been published on the global obesity epidemic and
global experience with metabolic and bariatric surgery, which has greatly improved the
understanding of obesity and its treatment [2,3]. Now recognized as a disease
chronic, obesity is associated with a chronic low-grade inflammatory state and dysfunction
immune [4,5].

With an ever-increasing global experience in bariatric and metabolic surgery, the studies
long term have shown that it is an effective and long-lasting treatment in severe obesity and
their comorbidities. Studies with long-term follow-up, published in the decades
subsequent to the 1991 NIH consensus statement, have consistently demonstrated
that surgery produces superior results in weight loss compared to
non-surgical treatments [6-11].

After surgery, significant improvement of metabolic disease as well as
decrease in overall mortality, has been reported in multiple studies that still support
plus the importance of this treatment modality [12-15].

At the same time, the safety of bariatric surgery has been studied and reported
extensively [16-19]. Perioperative mortality is very low, ranging between 0.03 and 0.03.
0.2% [20]. Therefore, it is not surprising that surgical treatment has become an
of the most commonly performed operations in general surgery [21].
The operations commonly performed have also evolved. The operations
Older surgical procedures have been replaced by safer and more effective operations. The
1991 NIH consensus statement described vertical band gastroplasty (VBG)
and Roux-en-Y gastric bypass (RYGB) as the dominant procedures in practice
clinic at that time. Currently, the dominant procedures are gastrectomy
in manga and RYGB, which together account for approximately 90% of all operations
performed around the world [22], In light of significant advances in the understanding of the disease of obesity, its management in general, and metabolic and bariatric surgery in particular, leaders of the American Society for Metabolic and Bariatric Surgery (ASMBS) and the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) have come together to produce this joint statement on the scientific information currently available on metabolic and bariatric surgery and its indications.

The 10 main recommendations of this new consensus are the following:

References
[1] Gastrointestinal surgery for severe obesity. Consens Statement 1991;9(1):1–20.
[2] Ogden CL, Carroll MD, Kit BK, Flegal KL. Prevalence of childhood and adult obesity in the United States 2011–12. JAMA
2014;311(8):806–14.
[3] World Health Organization (WHO). [monograph on the Internet], Geneva: World Health Organization; 2002. [cited
2022 Jul 1]. Avail- able from: https://www.who.int/publications/i/item/9241562072.
[4] Gossman H, Butsch WS, Jastreboff AM. Treating the chronic disease of obesity. Med Clin N Am 2021;105(6):983–1016.
[5] Kawai T, Autieri MV, Scalia R. Adipose tissue inflammation and metabolic dysfunction in obesity. Am J Physiol Cell
Physiol 2021;320(3):C375–91.
[6] Gloy VL, Briel M, Bhatt DL, et al. Bariatric surgery versus non- surgical treatment of obesity: a systematic review and
meta- analysis of randomised controlled trials. BMJ 2013;347:f5934.
[7] Adams TD, Davidson LE, Litwin SE, et al. Weight and metabolic outcomes 12 years after gastric bypass. N Engl J Med
2017; 377(12):1143–55.
[8] Sjostrom L, Lindroos AK, Peltonen M, et al. Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric
surgery. N Engl J Med 2004;351(26):2683–93.
[9] Sjostrom L, Peltonen M, Jacobson P, et al. Bariatric surgery and long- term cardiovascular events. JAMA
2012;307(1):56–65.
[10] Puzziferri N, Roshek III TB, Mayo HG, et al. Long-term follow-up after bariatric surgery: a systematic review. JAMA
2014;312(9): 935–42.
[11] MaciewjewskiML,ArterburnDE,VanScoyocL,etal.Bariatricsur- gery and long-term durability of weight loss. JAMA Surg
2016;151(11):1046–55.
[15] SchauerPR,MingroneG,IkramuddinS,WolfeB.Clinicaloutcomes of metabolic surgery: efficacy of glycemic control,
weight loss, and remission of diabetes. Diabetes Care 2016;39(6):902–11.
[12] Arterburn DE, Olsen MK, Smith VA, et al. Association between bariatric surgery and long-term survival. JAMA
2015;313(1): 62–70.
[13] SjostromL,NarbroK,SjostromCD,etal.Effectsofbariatricsurgery on mortality in Swedish obese subjects. N Engl J Med
2007; 357(8):741–52.
[14] Aminian A, Al-Kurd A, Wilson R, et al. Association of bariatric surgery with major adverse liver and cardiovascular
outcomes in patients with biopsy-proven nonalcoholic steatohepatitis. JAMA 2021;26(20):2031–42.
[15] Aminian A, Zajicheck A, Arterburn DE, et al. Association of meta- bolic surgery with major adverse cardiovascular
outcomes in patients with type 2 diabetes and obesity. JAMA 2019;322(13):1271–82.
[16] GoldbergI,YangJ,NieL,etal.Safetyofbariatricsurgeryinpatients older than 65 years. Surg Obes Relat Dis
2019;15(8):1380–7.
[17] Phillips BT, Shikora SA. The history of metabolic and bariatric sur-
gery: development of standards for patient safety and efficacy. Meta-
bolism 2018;79:97–107.
[18] The Longitudinal Assessment of Bariatric Surgery (LABS) Con-
sortium. Perioperative safety in the longitudinal assessment of bariat-
ric surgery. N Engl J Med 2009;361:445–54.
[19] BuchwaldH,EstokR,FahrbachK,BanelD,SledgeI.Trendsinmor-
tality in bariatric surgery: a systematic review and meta-analysis. Sur-
gery 2007;142(4):621–32.
[20] ArterburnDE,TelemDA,KushnerRF,etal.Benefitsandrisksofbar-
iatric surgery in adults: a review. JAMA 2020;324(9):879–87.
[21] American Society for Metabolic and Bariatric Surgery (ASMBS) [Internet]. Newberry, FL: The Society [updated 2022
Jun; cited 2022 Jul 1]. Estimate of Bariatric Surgery Numbers, 2011-2020; [about 2 screens]. Available from:
https://asmbs.org/resources/
estimate-of-bariatric-surgery-numbers.
[22] International Federation for the Surgery of Obesity and Metabolic
Disorders (IFSO). 5th IFSO Global Registry Report [monograph on the Internet]. Naples, Italy: IFSO; 2019 [cited 2022 Jul
1]. Avail- able from: https://www.ifso.com/pdf/5th-ifso-global-registry-report- september-2019.pdf.