Drs. Caroline M. Apovian and Louis J. Aronne examine the 2013 AHA/ACC/TOS Guideline for Management of Overweight and Obesity in Adults, paying special attention to the recommendation to advise obese adults who meet criteria that surgery may be an option in “Updates in Bariatric Surgery: Guidelines, Patient Selection,” presented by DiabetesSeriesLive.
Dr. Caroline M. Apovian, MD, FACN, AC, FTOS, DABOM, Professor of Medicine and Pediatrics, Boston University School of Medicine, Director, Center for Nutrition and Weight Management at Boston Medical Center, joins Dr. Louis J. Aronne, MD, FACP, FTOS, DABOM, Sanford I. Weill Professor of Metabolic Research, Director, Comprehensive Weight Control Center, Weill Cornell Medical College, Division of Endocrinology, Diabetes and Metabolism, New York, New York to discuss the AHA/ACC/TOS Guidelines and patient selection as it relates to bariatric surgery as a treatment option for obese adults.
Bariatric Guidelines: A Reminder of Key Recommendations
According to the 2013 AHA/ACC/TOS Guideline for the Management of Overweight and Obesity in Adults, there are six key recommendations:
- Use BMI to identify risk; advise patients of their risk
- Use waist circumference to identify risk; advise patients of their risk
- 3%-5% sustained weight loss reduces risk factors and risk of diabetes
- Prescribe set number of calories per day
- There is no ideal diet, and
- Advise obese adults who meet criteria that surgery may be an option. Discussion in this CME video focus on the risks and benefits of several surgical options.
Dr. Apovian reminds viewers that bariatric surgery is recommended for obese adults who meet the following criteria:
- BMI >= 40 or BMI >= 35 with obesity-related comorbid conditions (i.e. Type II Diabetes)
- Motivation to lose weight
- Have not responded to behavioral treatment with or without pharmacotherapy with sufficient weight loss to achieve targeted health outcome goals
Both Drs. point out surgery should not be a first line treatment, but should only be discussed as an option when all other modes of treatment have failed.
An Updated Review of Bariatric Surgery Procedures and Devices
Dr. Apovian includes discussion on surgical procedure options available as of 2013; Laparoscopic Adjustable Gastric Band (LABG), Laparoscopic Sleeve Gastrectomy (LSG), Roux-en-Y Gastric Bypass (RYGB), and Biliopancreatic Diversion (BPD).
The doctors consider each procedure with respect to the same criteria: Expected weight loss/mechanism, safety, common complications, postoperative metabolic management, reversibility, and cost.
Drs. Apovian and Aronne also give information and statistics regarding vagal blocking therapy and balloon devices.
What Works in Bariatrics: Efficacy Studies
In a meta-analysis of 147 studies, Dr. Apovian discusses 20-year results comparing different bariatric surgery options as well as touching on types of bariatric surgeries used on adolescents.
Data-Driven Discussion of Risks of Bariatric Surgery
The doctors expand on common surgical complications, referencing data that groups LSG, RYGB, and BPD together in comparison to LAGB.
Using results from updated research, Dr. Apovian and Dr. Aronne explain the key risks of bariatric surgery, even when applied in the right context.
Post-Surgery Patient Management
The last part of the presentation discusses postop management of patients, nutrition and metabolic consultations, and an AACE bariatric surgery postoperative checklist for early care and follow-up care.
Watch Drs. Apovian and Aronne discuss these updates and guidelines for CME credit on DiabetesSeriesLive during their presentation “Updates on Bariatric Surgery: Guidelines, Patient Selection.”
Disclaimer: All PlatformQ Health articles, reports, summaries, and recaps of events are for informational purposes. The quotes and opinions of the speakers covered are not to be taken as direct advice for individual patients. Patients should always seek care from qualified, properly accredited healthcare professionals.