Fast Five Quiz: Weight Loss

Romesh Khardori, MD, PhD


October 25, 2021

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.

Read more on bariatric surgery.

This Fast Five Quiz was excerpted and adapted from the Medscape Drugs & Diseases articles semaglutide (Rx) and Obesity Treatment & Management.

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