Appropriateness Criteria for Bariatric Surgery: Beyond the NIH Guidelines

• Published in: Obesity (Silver Spring, Md.) Md.), 2009-08, Vol.17 (8), p.1521-1527
• Main Authors: Yermilov, Irina, McGory, Marcia L, Shekelle, Paul W, Ko, Clifford Y, Maggard, Melinda A
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Age; Age Factors; Aged; bariatric surgery; Bariatric Surgery - methods; Bariatric Surgery - standards; Body Mass Index; body weight; Candidates; Child; chronic diseases; Comorbidity; Diabetes; Gastrointestinal surgery; Guidelines as Topic; Humans; Hypertension; medical treatment; Middle Aged; morbidity; National Institutes of Health (U.S.); Obesity; Obesity - surgery; obesity-related diseases; Patients; Risk; risk factors; risk reduction; Surgeons; United States; Weight control; weight control programs
• ISSN: 1930-7381; 1930-739X
• DOI: 10.1038/oby.2009.78

Careful selection of bariatric patients is critical for successful outcomes. In 1991, the NIH first established patient selection guidelines; however, some surgeons operate on individuals outside of these criteria, i.e., extreme age groups. We developed appropriateness criteria for the spectrum of patient characteristics including age, BMI, and severity of eight obesity‐related comorbidities. Candidate criteria were developed using combinations of patient characteristics including BMI: ≥40 kg/m2, 35–39, 32–34, 30–31, 9, on maximal medical therapy), is an appropriate criterion for those aged 19–64, whereas many mild to moderate severity comorbidity categories are “inappropriate.” There is overwhelming agreement among the panelists that the current evidence does not support performing bariatric surgery in lower BMI individuals (BMI