Criteria for bariatric surgery should consider more than just patient's weight

July 09, 2019

Experts at The Ohio State University Wexner Medical Center and 45 worldwide scientific and medical societies pushed for change to the national guidelines that would allow more patients with the chronic diseases of obesity and diabetes to be eligible for bariatric surgery at the 2019 Annual Minimally Invasive Surgery Symposium by Global Academy for Medical Education.

Obesity affects almost 40% of the population - or about 93 million adults - in the United States, according to the Centers for Disease Control and Prevention.

As chronic obesity worsens, it comes not only with complications of diabetes, but may also include heart disease and cancer. And just like with any other chronic disease, the best course of action is early intervention, such as bariatric surgery, said Dr. Stacy Brethauer, a surgeon at Ohio State Wexner Medical Center's Bariatric Surgery Center of Excellence.

Bariatric surgery is a weight-loss technique that changes the anatomy of the gastrointestinal tract including the stomach and digestive system and creates physiological changes in the body that alter energy balance and fat metabolism.

"Surgery is, by far, the most effective tool in managing or reversing Type 2 diabetes. Just as doctors wouldn't wait until a patient has advanced-stage cancer to treat their disease, patients shouldn't have to wait until they are severely obese to undergo surgery," Brethauer said. "Too many see obesity as a problem of willpower, and it's simply not. 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."

Patients with obesity who are interested in having bariatric surgery to lose weight must meet certain criteria to qualify for the surgery that were developed nearly three decades ago, and are arbitrarily based on a patient's body mass index (BMI), Brethauer said.

According to the 1991 National Institutes of Health Consensus Conference Guidelines, patients are considered surgical candidates only if their BMI is 40 or higher, or if their BMI is 35 or higher and they suffer from other life-threatening comorbidities such as type 2 diabetes, hypertension or cardiovascular disease.

"For example, if you have two patients who each have obesity with uncontrolled diabetes, the patient who has a BMI of 35 or higher would qualify for bariatric surgery, while the other patient with a BMI of 34 or lower would often be denied coverage by insurance companies," Brethauer said. He wants this to change.

Multiple clinical studies have proven the benefits of bariatric surgery in patients with lower BMIs. The American Society for Metabolic and Bariatric Surgery has drafted new criteria that would make these patients eligible for surgery with a lower BMI and diabetes, said Brethauer, a senior past president of the society who helped draft the new guidelines during his tenure as president.

"The patient who doesn't get the operation, we know very well that their disease will progress and their lifespan will be shortened," said Brethauer, professor of surgery at Ohio State's College of Medicine. "Continuing to increase their insulin requirements will not change the trajectory of the disease. Surgery does."

Brethauer said it's now up to referring physicians and insurance companies to more widely adopt these new standards so that more patients can receive the treatment they need.

In 2016, global guidelines developed during the 2nd Diabetes Surgery Summit were published in the journal Diabetes Care to inform clinicians and policymakers about benefits and limitations of bariatric surgery for patients with type 2 diabetes. These guidelines have been endorsed by more than 45 scientific and medical societies worldwide that urge health care regulators to introduce appropriate reimbursement policies.

"National data says that two-thirds of the population is either overweight or obese, and up to 8% are severely obese and clearly would qualify for bariatric surgery," Brethauer said. "But right now in the United States, we do more than 250,000 bariatric surgeries a year, so that means we're operating on 1% of the patients who are eligible for surgery based on their BMI."

Ohio State University Wexner Medical Center

Related Diabetes Articles from Brightsurf:

New diabetes medication reduced heart event risk in those with diabetes and kidney disease
Sotagliflozin - a type of medication known as an SGLT2 inhibitor primarily prescribed for Type 2 diabetes - reduces the risk of adverse cardiovascular events for patients with diabetes and kidney disease.

Diabetes drug boosts survival in patients with type 2 diabetes and COVID-19 pneumonia
Sitagliptin, a drug to lower blood sugar in type 2 diabetes, also improves survival in diabetic patients hospitalized with COVID-19, suggests a multicenter observational study in Italy.

Making sense of diabetes
Throughout her 38-year nursing career, Laurel Despins has progressed from a bedside nurse to a clinical nurse specialist and has worked in medical, surgical and cardiac intensive care units.

Helping teens with type 1 diabetes improve diabetes control with MyDiaText
Adolescence is a difficult period of development, made more complex for those with Type 1 diabetes mellitus (T1DM).

Diabetes-in-a-dish model uncovers new insights into the cause of type 2 diabetes
Researchers have developed a novel 'disease-in-a-dish' model to study the basic molecular factors that lead to the development of type 2 diabetes, uncovering the potential existence of major signaling defects both inside and outside of the classical insulin signaling cascade, and providing new perspectives on the mechanisms behind insulin resistance in type 2 diabetes and possibly opportunities for the development of novel therapeutics for the disease.

Tele-diabetes to manage new-onset diabetes during COVID-19 pandemic
Two new case studies highlight the use of tele-diabetes to manage new-onset type 1 diabetes in an adult and an infant during the COVID-19 pandemic.

Genetic profile may predict type 2 diabetes risk among women with gestational diabetes
Women who go on to develop type 2 diabetes after having gestational, or pregnancy-related, diabetes are more likely to have particular genetic profiles, suggests an analysis by researchers at the National Institutes of Health and other institutions.

Maternal gestational diabetes linked to diabetes in children
Children and youth of mothers who had gestational diabetes during pregnancy are at increased risk of diabetes themselves, according to new research published in CMAJ (Canadian Medical Association Journal).

Two diabetes medications don't slow progression of type 2 diabetes in youth
In youth with impaired glucose tolerance or recent-onset type 2 diabetes, neither initial treatment with long-acting insulin followed by the drug metformin, nor metformin alone preserved the body's ability to make insulin, according to results published online June 25 in Diabetes Care.

People with diabetes visit the dentist less frequently despite link between diabetes, oral health
Adults with diabetes are less likely to visit the dentist than people with prediabetes or without diabetes, finds a new study led by researchers at NYU Rory Meyers College of Nursing and East Carolina University's Brody School of Medicine.

Read More: Diabetes News and Diabetes Current Events is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to