IntroductIonEvidence-based best practice guidelines for multidisciplinary care in weight loss surgery (WLS) have been previously described (1). Earlier recommendations focused on patient selection/screening, operative risk, medical evaluation, nutrition counseling, and postoperative care (2). This report covers key updates in these and other areas.Because extreme obesity can potentially affect all organ systems and psychological health (3), optimal surgical treatment of WLS requires communication and collaboration among a multidisciplinary team of caregivers. This article establishes the most current best practice guidelines for multidisciplinary care, with a focus on long-term outcomes and patient safety. Methods And ProceduresWe searched MEDLINE and the Cochrane Library for articles published on WLS and patient selection, medical, multidisciplinary, and nutritional care published between April 2004 and April 2007. The system used to grade the quality of the evidence has already been described (1). We identified >150 papers; the 112 most relevant were reviewed in detail. These included randomized controlled trials, prospective and retrospective cohort studies, meta-analyses, case reports, prior systematic reviews, and expert opinion. The focus of the recommendations and the process used to develop them are reported elsewhere (1). results Multidisciplinary careIn February 2006, the Centers for Medicare and Medicaid Services decided to cover WLS performed at accredited facilities, such as Centers of Excellence (4). These are defined as facilities that meet standards of multidisciplinary care set by the American Society for Metabolic and Bariatric Surgery (4) and the American College of Surgeons (5).However, existing guidelines on multidisciplinary care are vague. The 1991 National Institutes of Health consensus report on Gastrointestinal Surgery for Severe Obesity recommended multidisciplinary teams with medical, surgical, psychiatric, and nutritional expertise (6). Based on results from a national survey, 93% of respondents used a multidisciplinary approach to treat WLS patients, but only 53% had the National Institutes of Health-recommended team, and only 47% required the National Institutes of Health-recommended evaluations (7). The objective of this study is to update evidence-based best practice guidelines for multidisciplinary care of weight loss surgery (WLS) patients. We performed systematic search of English-language literature on WLS, patient selection, and medical, multidisciplinary, and nutritional care published between April 2004 and May 2007 in MEDLINE and the Cochrane Library. Key words were used to narrow the search for a selective review of abstracts, retrieval of full articles, and grading of evidence according to systems used in established evidence-based models. A total of 150 papers were retrieved from the literature search and 112 were reviewed in detail. We made evidence-based best practice recommendations from the most recent literature on multidisciplinary care of WLS patients. New reco...

Obesity is associated with an increased risk of developing insulin resistance and type 2 diabetes mellitus (T2DM). In obesity, the adipose cell releases non-esterified free fatty acids, hormones, adipocytokines, and other substances that are involved in insulin resistance. Under normal conditions, the pancreatic islet β cells increase production of insulin sufficiently to maintain normal blood glucose concentrations despite insulin resistance. However, in genetically predisposed patients, the β cells eventually become dysfunctional and T2DM develops. The development of T2DM can be delayed or sometimes prevented in individuals with obesity who are able to lose weight. Weight loss can be achieved medically with behavioral therapies that combine diet and exercise treatment or with behavioral therapies combined with weight-loss medications or weight-loss surgery. In this article, we summarize the evidence of obesity management in treating T2DM and prediabetes.

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