Fast Five Quiz: Weight Loss

Guidelines from the American Association of Clinical Endocrinology (AACE)/American College of Endocrinology (ACE), TOS, the American Society for Metabolic & Bariatric Surgery (ASMBS), Obesity Medicine Association (OMA), and American Society of Anesthesiologists (ASA) state that laparoscopic adjustable gastric banding, laparoscopic sleeve gastrectomy, laparoscopic Roux-en-Y gastric bypass, and laparoscopic biliopancreatic diversion without/with duodenal switch, or related procedures, should be considered as primary bariatric and metabolic procedures performed in patients requiring weight loss and/or amelioration of obesity-related complications.

Patients should be considered candidates for bariatric procedures only if they have a BMI of more than 40 kg/m² and/or a weight greater than 45 kg above the age- and sex-defined ideal weight. For persons with BMIs of 35-40 kg/m², at least one major comorbidity must be present to justify these procedures. The presence of comorbidities is not a contraindication to bariatric surgical procedures; however, the patient's condition must be stabilized and adequately treated before surgery. According to the AACE/ACE/TOS/ASMBS/OMA/ASA guidelines, patients with a BMI of 35 kg/m² or higher and one or more of the following should be considered for a bariatric procedure:

Type 2 diabetes mellitus
Hypertension
NAFLD or nonalcoholic steatohepatitis
Obstructive sleep apnea
Osteoarthritis of the knee or hip
Urinary stress incontinence

Patients who undergo gastric bypass lose between 50% and 80% of excess body weight within 12-18 months. Patients who undergo gastric sleeve procedures lose between 60% and 70% of excess body weight within 12-18 months.

Tobacco use ideally should be discontinued for a year prior to bariatric procedures. At a minimum, guidelines recommend cessation at 6 weeks prior, particularly among those who smoke cigarettes.