Obesity has been declared a disease by the American Medical Association in 2013. As a disease like any other, obesity will benefit from earlier intervention. Consistent data demonstrated here displays the benefit of bariatric surgery in lower Body Mass Index (BMI) specifically BMI 30-35 and particularly for diabetic patients. There is abundant data to support that obesity is a chronic disease and without intervention will worsen. Along with many payors and policy makers, ASMBS endorses bariatric surgery in BMI 30-35.
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 a 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,