Physicians Question Lowering of BMI Requirements for Bariatric Surgery

The American Society of Bariatric Physicians (ASBP; Aurora, CO, USA) has expressed concern that at the same time that an advisory panel of the US Food and Drug Administration (FDA, Silver Spring, MD, USA) recommended lowering the body mass index (BMI) requirement for lap-band surgery, the FDA has denied two new obesity medications.

The ASBP stated that it supports medically supervised weight loss programs as the treatment of choice for patients with BMIs between 30 and 35, and believes that the new recommendation of lap-band surgery for patients with BMIs of 30 and above is premature, and carries risks that have not yet been considered. The ASBP further added that bariatric surgery is drastic and expensive, and carries higher morbidity and mortality risks than lifestyle interventions or medication. Thus, patients who could have otherwise lost weight in a nonsurgical medical bariatric program may now be encouraged to skip medical therapy and jump directly to surgery.

Before a patient ever considers surgery, the ASBP advocates that the patient first seek the help of a qualified bariatric physician, who will start with a complete patient work-up, ensuring that metabolic and overall health are not compromised. Proper implementation of a medically managed weight loss program by a bariatric physician can lead to tremendous success, with long-term reversal of obesity related comorbidities equivalent to surgical interventions, minus the risks.

"The ASBP concludes that bariatric surgery is not a quick fix or an easy answer to the obesity epidemic,” the statement reads. "Bariatric surgery has been and should remain a second line therapy after comprehensive medically-managed weight loss. Bariatric surgery does not end one's challenges with weight; rather, it creates new and different nutritional, medical, and psychiatric challenges that must be carefully considered.”

Bariatric surgery is often accompanied by side effects and substantial failure rates. Almost 30% of bariatric surgery patients regain the weight they initially lost or have the surgery reversed, according to long-term studies, and a recent study found that there was a five-fold increase of suicides among all patients who had bariatric surgery, most occurring within three years following the surgery. Weight loss surgery also causes nutritional deficiencies requiring lifelong supplementation of calcium, vitamin B12, folate, multivitamins, iron, and thiamine.

Related Links:
American Society of Bariatric Physicians
US Food and Drug Administration