Patient selection prior to bariatric surgery

Abstract

Obesity is a worldwide epidemic. With the increased incidence of obesity, the metabolic derangements associated with it have increased exponentially. Bariatric surgery has long been recognized as the most effective and durable therapy for morbid obesity. The safety profile and positive effects of these procedures have resulted in a significant increase in their utilization. However, in order to achieve optimal results and minimize possible complications, appropriate candidates should be selected. The main indications for bariatric surgery were established in the NIH conference more than two decades ago: patients with a body mass index (BMI) between 35 and 40 kg/m2 with comorbidities such as diabetes, hypertension, and obstructive sleep apnea or patients with a BMI greater than 40 kg/m2 with or without comorbidities. Proper medical, psychological, and nutritional screening is paramount for the short- and long-term success of these procedures. Based on the positive metabolic effects of bariatric surgery, more studies have suggested an expansion of their indications to the lower BMI population with the express purpose of improving the metabolic derangements.