Preamble

The American Society of Metabolic and Bariatric Surgery’s aim is to decrease the burden of obesity. To meet that challenge, ASMBS endorses a multi-disciplinary approach to best prepare a patient for surgery. As compassionate and capable surgeons, we strive to provide evidence-based care for our patients. As this data repository demonstrates, there are no data to support mandated, time-specific preoperative weight loss requirements. Patients with obesity presenting to bariatric surgical clinics have attempted weight loss on multiple occasions. Obese patients’ inability to lose weight on prior occasions is precisely why they seek surgical care. While we support weight loss from a health benefit, we do not support a mandated time period. A bariatric surgical team is capable of providing the best approach and time frame in preparing a patient for surgery. Any policy mandating a specific time period or approach to preoperative weight loss is not evidence-based and will prevent patients from seeking definitive treatment.

In addition, we endorse, like many payors, that the initial consult BMI is the BMI of record for preoperative assessment. If a patient is fortunate enough to lose weight preoperatively and have a BMI 30-35 in the immediate preoperative visit, then this patient should be entitled to surgical intervention and not be disenfranchised from an safe, effective and enduring treatment. The chronic nature of obesity ensures that a pre-operative patient who loses weight non-surgically has a strong likelihood to regain that weight; as such, a patient with an initial consult BMI >35 should have the ability to have surgery regardless of any short-term, pre-operative weight loss. This is the only approach to follow with a bariatric surgery patient to prevent a perverse incentive to increase weight to meet a BMI threshold and place the pre-operative patient at risk.

On behalf of the American Society for Metabolic and Bariatric Surgery,

John M. Morton, MD, MPH, FASMBS

John Magaña Morton, MD, MPH, FASMBS

2014-2015 President