New 2022 Guidelines for Weight Loss Surgery

You may have heard the big news about bariatric surgery. The American Society for Metabolic and Bariatric Surgery (ASMBS) and the International Federation for the Surgery of Obesity (IFSO) updated bariatric procedure guidelines at the end of 2022. This was the first update in over 30 years. Body Mass Index or BMI was, and still remains, the primary determinant of whether someone qualifies for bariatric surgery. However, the BMI ranges have been updated to better reflect what we know about obesity and its effects.

To fully understand the implications of this new guidance, we must know more about the body mass index or BMI. Body mass index is a relatively simplistic calculation of height versus weight to estimate a patient’s ideal weight. According to the index, patients can be underweight, normal, overweight, or obese. First and foremost, these BMI numbers cannot accurately predict the diseases associated with morbid obesity. For example, some patients with a BMI of 30 may have significant comorbidities, while others with a BMI of 35 may have fewer and less severe problems. When we reach the higher BMIs – 40 and over – most patients have one or more comorbidities. Also, the BMI does not consider gender differences, muscle mass, body structure, and other critical factors that can help us determine if a patient is a good candidate for surgery. For example, a bodybuilder will often classify as obese when they certainly are not.

The New Guidance

With that said, we can jump right into the new guidelines. Today, the guidance suggests that patients with a BMI of 35 or over, regardless of their comorbidities, can consider bariatric surgery as a solution to their excess weight. Patients with a BMI of 30 or above with one or more obesity-related comorbidities may also be candidates. Those of Asian descent can consider bariatric surgery with a BMI as low as 27.5. The two former numbers are down five points from previous guidance and reflect that many people experience significant morbidity at lower BMIs than we once thought. Similarly, the guidelines for patients of Asian descent have been introduced because of our understanding that some ethnicities experience co-morbidities at lower BMIs than others.

What Does This Mean Practically?

While this is big news and allows us to perform surgery on lower BMI cash-pay patients, not much has changed for those pursuing the insurance route. First, government organizations and private insurance companies have not yet adopted these guidelines as the standard for their qualification criteria. There is an inevitable lag between these announcements and when they are implemented. This means that anybody newly qualified under this relaxed guidance will not have insurance coverage for bariatric surgery until these organizations adopt the standards. For patients looking for cash pay and who would have otherwise not qualified for bariatric surgery, we encourage you to call our office to see if bariatric surgery may be the right option.

What Can You Do Today?

It’s never too early to start the weight-loss process, and today you can start by eliminating the worst foods and drinks that add empty calories to your diet. These are the desserts, processed foods, white grains, and sugars you may eat or drink. This is also a great time to start an exercise program. You don’t necessarily have to bench 300 pounds or run a mile. Walking down the street as much as possible without overstraining your body can be helpful. This is also a great way to prepare yourself for your eventual surgery, as even minor weight loss can reduce the risk of a surgical procedure.

We encourage you to watch our online seminar and learn more about our practice. Whether you make a cash payment for your procedure or use your insurance, we want you to get to know Dr. Chang at the office and what responsibilities you should expect to have both before and after the procedure. In the meantime, if you’re reading this, we applaud you for taking a huge step forward in your health, and we are here to answer questions whenever you need.