View this email in your browser
This Issue
New Guidelines for Bariatric Surgery
STOP Resources                 
Educators       Providers         Parents

This month's newsletter is written by guest author Shanu N. Kothari, MD, FACS, FASMBS. He is the Jean and H. Harlan Stone Chair of Surgery at Prisma Health in Greenville, SC. He is also Professor of Surgery at the University of South Carolina – Greenville. He is the immediate past president of the American Society for Metabolic and Bariatric Surgery.


The year 1991 was a significant year in our country’s history. Herbert Walker Bush was President of the United States. The number one movie in the United States was Silence of the Lambs. The internet became commercially available. Mikhail Gorbachev resigned as president of the Soviet Union. It was also the year that the National Institutes of Health (NIH) published their consensus guidelines for indications for bariatric surgery.

The NIH guidelines stated that surgery was indicated for patients with the BMI of 40 or greater or 35 to 39.9 with significant comorbidities after multiple failed dietary attempts. In the past 31 years, not only has our country undergone significant changes, our understanding of the disease of obesity along with safety, reliability, and reproducibility of our various interventions has changed as well. We now have six American Society of Metabolic and Bariatric Surgery (ASMBS) endorsed surgical procedures. We have a wealth of literature touting the benefits of minimally invasive procedures over our traditional open techniques, specifically around decreased wound related morbidity, incisional hernias, and decreased length of stay, all of which have transformed the care of our patients. Now, we have multiple prospective randomized trials on a variety of surgical procedures showing the superiority of metabolic and bariatric surgical intervention to maximal medical therapy for not only weight loss but Type 2 diabetes as well. Consequently, an update to the NIH Consensus Conference from 1991 is long overdue.

In addition, the National Institutes of Health is no longer in the business of creating consensus guidelines and as a result, we are trapped in the past. ASMBS took this opportunity, working with the International Federation for the Society of Obesity (IFSO), to update these guidelines. I am happy to report that this collaborative international effort has resulted in open access to the guidelines through both of our leading journals, Surgery for Obesity And Related Disease (SOARD) as well as Obesity Surgery.
Based on the new guidelines, metabolic and bariatric surgery (MBS) is recommended for individuals:

  • with a BMI greater than 35 kg / m² regardless of presence, absence, or severity of comorbid conditions,
  •  with type 2 diabetes with a BMI greater than 35 kg / m², and
  • should be considered in individuals with a BMI of 30 – 34.9 kg / m² who cannot achieve substantial or durable weight loss or comorbidity improvement using nonsurgical methods.

In addition, our current BMI thresholds for obesity discriminate against those of Asian ethnicity where comorbid conditions such as type 2 diabetes and high blood pressure impact the Asian population at a lower BMI. Based on these data, we have lowered the BMI threshold to 27.5 for consideration of metabolic surgical intervention in patients of Asian ethnicity.

Other changes include no upper age limit to MBS. This is a risk benefit analysis that should be completed on an individual basis with input from a multidisciplinary team and is the surgeon making the decision in a shared decision-making approach with the patient. We know that chronological age in and of itself is not a contraindication and that frailty index would be a better marker of risk in this population. In addition, children and adolescents with a BMI greater than 120% of the 95 percentile and a major comorbidity or BMI greater than 140% of the 95 percentile should be considered for MBS after evaluation by a multidisciplinary team in a specialized center. The updated guidelines also recommend MBS as a bridge to other surgical specialty interventions including joint arthroplasty, abdominal wall hernia repair, and organ transplantation. Finally, like many other diseases, obesity is a chronic disease requiring lifelong management after any intervention including primary metabolic surgery. This may include revisional surgery or other therapies including endoscopic and pharmaceutical interventions to achieve a desired treatment effect.

Now that we have armed our membership of our respective societies with these updated guidelines and have the endorsement of over 72 countries, it is time to take this message to the payors. We have already begun to see anecdotal wins on peer-to-peer reviews, getting denials overturned based on our new 2022 guidelines. The next steps are to go to the various payors and to get their indications for metabolic surgery to match the 2022 guidelines and to abolish the 1991 guidelines. Ultimately, our goal will also be to get CMS to endorse these updated evidence-based indications for metabolic and bariatric surgery.

Finally, we must stop referencing the 1991 guidelines in all our publications and use the 2022 guidelines moving forward for all publications. This will truly take a grass roots effort from everyone who is involved in the treatment of obesity for us to see the worldwide adoption of the 2022 ASMBS/IFSO Indications for metabolic and bariatric surgery.



  Shanu N. Kothari, MD, FACS, FASMBS
  The Jean and H. Harlan Stone Chair of Surgery

  Professor of Surgery, USC School of Medicine Greenville
  President Elect, The Fellowship Council
  Immediate Past President, American Society for Metabolic and Bariatric Surgery


Share Share
Tweet Tweet
Forward Forward
Upcoming Events

Dec 7: COPE Webinar -- Physical Activity 
Dec 8: COPE Webinar -- Food as Medicine

Health Affairs Forefront Piece
Roundtable Workshop Materials
Grant and Research Awards with ASN
NUTRITION 2023 Announcement
Dr. Dietz Publishes Health Affairs Forefront Piece on 2022 White House Conference
Dr. Bill Dietz has published a piece in Health Affairs Forefront on the 2022 White House Conference on Hunger, Nutrition, and Health. In the article, titled "Will the White House's Pledge to End Hunger and Reduce Diet-Related Diseases Succeed?" Dr. Dietz describes the conference and the resulting National Strategy on Hunger, Nutrition, and Health

Read the article here.
Roundtable on Obesity Solutions Workshop Materials Available Online
The Roundtable on Obesity Solutions of the National Academies of Sciences, Engineering, and Medicine convened a series of workshops on how to bridge evidence gaps within foundational drivers of obesity and translate knowledge towards actionable solutions. The second workshop in this series, Engaging Communities in Addressing Structural Drivers of Obesity, focused on community engagement in obesity solutions. It explored barriers and opportunities for community engagement and highlighted examples of community initiatives that emphasize the intersection of obesity with structural racism, bias and stigma, and health communication to address needs identified by communities and foster changes to support health and wellness. The Proceedings of a Workshop-In Brief summarizes the discussions held during the workshop.

Read the proceedings here.
Upcoming Webinars with COPE
Promoting Physical Activity and Cardiovascular Health in Clinical Practice
December 7, 12-1pm ET

Although a recent scientific statement from the American Heart Association recommends physical activity as an effective lifestyle intervention and first line treatment for new diagnosis of mild-moderate elevations of blood pressure and cholesterol, few clinicians have the knowledge or skills to prescribe and support this behavior change. In this session, Dr. Bethany Barone Gibbs will review the latest physical activity guidelines in depth, describe how physical activity is an excellent strategy for promoting cardiovascular health in patients (including those with a new diagnosis of hypertension or high cholesterol), and will provide practical strategies and resources to improve physical activity promotion in a clinical setting.  

Learn more and register here.
Food as Medicine in Wellness and Disease: Practical Applications in Medical and Nutrition Education
December 8, 5:30pm ET

Boost nutrition science and culinary medicine education in your medical students’ and/or other healthcare professionals’ curriculum. Learn practical strategies for incorporating culinary instruction into curriculum to enhance the learning of core nutrition principles and competencies for the promotion of wellness and disease prevention and management. An in-depth specific example of a culinary medicine “lab” developed for medical education will be provided, including the educational component of the lab (which focuses on teaching the nutrition science) and the cooking demo component of the lab (which focuses on utilizing recipes to reinforce nutrition science content).

Learn more and register here.
Grant and Award Opportunities with ASN
$25,000 Grant Opportunity: Adversarial Collaboration

The Adversarial Collaboration Proposal program provides a unique opportunity for two scientists with opposing view to prepare a research plan to advance the science on a controversial topic related to nutrition or obesity.  In addition to a $25,000 planning grant, the winning team will receive travel for two to NUTRITION 2023 (July 22-25, Boston) and will be invited to present. The deadline to submit research proposals is February 17, 2023.

Learn more here.

American Society for Nutrition Seeks Nominations/Submissions for the 2023 George Bray Outstanding Scientific Achievements Award in Obesity Research
  • The George Bray Outstanding Scientific Achievements Award in Obesity Research will be presented to a physician, clinician or investigator who has made a significant lifetime contribution to the field of obesity research. This award is designed to recognize an individual whose lifetime body of work includes meaningful contributions and/or demonstration of highly original, sustained, and reproducible scholarship that has made major contributions to the understanding of the causes, treatment and/or prevention of obesity. The recipient of this award will present an award lecture at NUTRITION 2023 (July 22-25, Boston). Deadline for nominations:  January 9, 2023. Learn more here.
  • George Bray Obesity Research Student Awards recognizes the two students with the highest-scoring abstracts in a topical area related to the causes, treatment or prevention of obesity presenting outstanding research during NUTRITION 2023. Deadline for abstract submissions: March 1, 2023. Learn more here.
NUTRITION 2023 Returns to Boston in July of 2023
The premier event for the latest in nutrition research which will bring the nutrition community together again July 22 – 25, 2023 in Boston, MA.
  • Abstract submission opens December 5th and closes March 1, 2023
  • Submit an award nomination by January 9, 2023
  • Tell us what you want to see at NUTRITION 2023!
Learn more and submit your ideas here.
Copyright © 2022 STOP Obesity Alliance, All rights reserved.

Want to change how you receive these emails?
You can update your preferences or unsubscribe from this list.

Email Marketing Powered by Mailchimp