The American College of Metabolic and Bariatric Surgery just published its guidelines about indications for bariatric surgery. These are what insurers use to determine who qualifies for eligibility for surgery.
According to these guidelines, bariatric surgery may be considered medically necessary for patients with
- a BMI greater than or equal to 35 kg/m2
- or a BMI greater than equal to 30 kg/m2 with at least ONE clinically significant obesity-related disease such as
- type 1 or 2 diabetes mellitus
- sleep apnea
- coronary artery disease
- osteoarthritis of the legs
- high cholesterol
- gastroesophageal reflux disease
- patient has failed to achieve a BMI less than 30kg/m2 with conservative measures - such as nutrition counseling or pharmacologic treatments for at least 3 of the last 6 months
We would note that the threshold for surgery is even lower for Asian individuals - here at BMI > or = 32.5kg/m2 or >27.5kg/m2 with one complication would suffice. The reason here being that Asian individuals are considered to be at higher risk for obesity-related complications at lower BMI levels.
The previous guidelines were much stricter. The ACMBS used to set its thresholds higher by 5 points of BMI. This meant that, bariatric surgery was confined to patients whose BMI was either > = 40 kg/m2 or >35 kg/m2 with a complication.
The new expanded eligibility reflects the fact that bariatric surgery continues to demonstrate, afer more than three decades and hundreds of high-quality studies, including randomized clinical trials, high levels of safety and effectiveness. Additionally, multiple studies have shown that new techniques in surgery - now increasingly done laparoscopically and robotically (both of which are performed by Dr. Mullangi here in southern California), are safer and more effective for patients.
Roughly 1-2% of the world's eligible patient population gets weight-loss surgery every year. It is possible that previously restrictive gudielines contributed to the limited use of this proven treatment. Meanwhile, the CDC reports that 42% of Americans have obesity, the highest ever rate in the US.
Please make an appointment to discuss your eligibility for surgery and surgical options with Dr. Mullangi today.