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American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery Medical Guidelines for Clinical Practice are systematically developed statements to assist health‐care professionals in medical decision making for specific clinical conditions. Most of the content herein is based on literature reviews. In areas of uncertainty, professional judgment was applied. These guidelines are a working document that reflects the state of the field at the time of publication. Because rapid changes in this area are expected, periodic revisions are inevitable. We encourage medical professionals to use this information in conjunction with their best clinical judgment. The presented recommendations may not be appropriate in all situations. Any decision by practitioners to apply these guidelines must be made in light of local resources and individual patient circumstances. The American Society for Parenteral & Enteral Nutrition fully endorses sections of these guidelines that address the metabolic and nutritional management of the bariatric surgical patient.

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These guidelines provide evidence-based details of how to achieve the successful dietary management of IBS.

Body condition scoring (BCS) systems primarily assess body fat. Both overweight and underweight animals may have loss of lean tissue that may not be noted using standard BCS systems. Catabolism of lean tissue can occur rapidly, may account for a disproportionate amount of body mass loss in sick cats and can have deleterious consequences for outcome. Therefore, along with evaluation of body fat, patients should undergo evaluation of muscle mass. The aims of the present study were first to evaluate the repeatability and reproducibility of a 4-point feline muscle mass scoring (MMS) system and second to assess the convergent validity of MMS by dual-energy X-ray absorptiometry (DXA). MMS was as follows: 3, normal muscle mass; 2, slight wasting; 1, moderate wasting; 0, severe wasting. For the first aim, forty-four cats were selected for evaluation based on age and BCS, and for the second aim, thirty-three cats were selected based on age, BCS and MMS. Cats were scored by ten different evaluators on three separate occasions. Body composition was determined by DXA. Inter-and intra-rater agreement were assessed using kappa analysis. Correlation between MMS and BCS, age, percentage lean body mass and lean body mass (LBM) was determined using Spearman's rank-order correlation. The MMS showed moderate inter-rater agreement in cats that scored normal or severely wasted (k ¼ 0·48 -0·53). Intra-rater agreement was substantial (k ¼ 0·71-0·73). The MMS was significantly correlated with BCS (r 0·76, P,0·0001), age (r 20·75, P, 0·0001), LBM (g) (r 0·62, P, 0·0001) and percentage LBM (r 20·49, P,0·0035). Additional investigation is needed to determine whether the MMS can be refined and to assess its clinical applicability.

The objective was to describe differences in weight loss, dietary intake, and cardiovascular risk factors between white and African-American patients after gastric bypass (GBP). Research Methods and Procedures:This was a retrospective database review of a sample of 84 adult patients (24 African-American and 60 white women and men) between the ages of 33 and 53 years. All subjects had GBP surgery in 2001 at the Bariatric Surgery Program at Boston Medical Center in Boston, MA, and were followed for one year postoperatively. Patients were excluded if weight data were missing at baseline, 3 months, or 1 year after GBP. A total of 9 African Americans and 41 whites provided data at all 3 time-points and were included in the study. Differences in weight loss, diet, and cardiovascular risk factors were analyzed.Results: There were no differences in baseline characteristics between African Americans and whites. Mean weight loss for the entire sample was 36 Ϯ 9%, with a range of 8% to 54% relative to initial body weight. Whites lost more weight (39 Ϯ 8%) than African Americans (26 Ϯ 10%) (p Ͻ 0.05). Dietary parameters, as well as improvements in blood pressure and lipid profiles, were similar in the two racial groups. Discussion: Differences in weight loss between severely obese African Americans and whites undergoing open GBP are unlikely to be related to postoperative dietary practices. Our data are consistent with previous reports implicating metabolic differences between the two racial groups.

Criteria for patient selection and multidisciplinary evaluation and treatment of the weight loss surgery patient. Obes Res. 2005;13:234 -243. Objective: To provide evidence-based guidelines for patient selection and to recommend the medical and nutritional aspects of multidisciplinary care required to minimize perioperative and postoperative risks in patients with severe obesity who undergo weight loss surgery (WLS). Research Methods and Procedures: Members of the Multidisciplinary Care Task Group conducted searches of MEDLINE and PubMed for articles related to WLS in general and medical and nutritional care in particular. Pertinent abstracts and literature were reviewed for references. Multiple searches were carried out for various aspects of multidisciplinary care published between 1980 and 2004. A total of 3000 abstracts were identified; 242 were reviewed in detail. Results: We recommended multidisciplinary screening of WLS patients to ensure appropriate selection; preoperative assessment for cardiovascular, pulmonary, gastrointestinal, endocrine, and other obesity-related diseases associated with increased risk for complications or mortality; preoperative weight loss and cessation of smoking; perioperative prophylaxis for deep vein thrombosis and pulmonary embolism (PE); preoperative and postoperative education and counseling by a registered dietitian; and a well-defined postsurgical diet progression. Discussion: Obesity-related diseases are often undiagnosed before WLS, putting patients at increased risk for complications and/or early mortality. Multidisciplinary assessment and care to minimize short-and long-term risks include: comprehensive medical screening; appropriate pre-, peri-, and postoperative preparation; collaboration with multiple patient care disciplines (e.g., anesthesiology, pulmonary medicine, cardiology, and psychology); and long-term nutrition education/counseling.

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...