Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient—2013 update: Cosponsored by american association of clinical endocrinologists, The obesity society, and american society for metabolic & bariatric surgery*

Abstract

The development of these updated guidelines was commissioned by the AACE, TOS, and ASMBS Board of Directors and adheres to the AACE 2010 protocol for standardized production of clinical practice guidelines (CPG). Each recommendation was re-evaluated and updated based on the evidence and subjective factors per protocol. Examples of expanded topics in this update include: the roles of sleeve gastrectomy, bariatric surgery in patients with type-2 diabetes, bariatric surgery for patients with mild obesity, copper deficiency, informed consent, and behavioral issues. There are 74 recommendations (of which 56 are revised and 2 are new) in this 2013 update, compared with 164 original recommendations in 2008. There are 403 citations, of which 33 (8.2%) are EL 1, 131 (32.5%) are EL 2, 170 (42.2%) are EL 3, and 69 (17.1%) are EL 4. There is a relatively high proportion (40.4%) of strong (EL 1 and 2) studies, compared with only 16.5% in the 2008 AACE-TOS-ASMBS CPG. These updated guidelines reflect recent additions to the evidence base. Bariatric surgery remains a safe and effective intervention for select patients with obesity. A team approach to perioperative care is mandatory with special attention to nutritional and metabolic issues.

Psychosomatic and Psychosocial Questions Regarding Bariatric Surgery: What Do We Know, or What Do We Think We Know?

“…At the same time, the evaluation should address the social support that can be expected to determine postoperative compliance (de Zwaan et al 2006). Such an assessment or medical opinion is justified by the frequent comor- bid mental disorders in bariatric surgery patients on the one hand (Dawes et al 2016;Herpertz et al 2006;Mauri et al 2008;Rosenberger et al 2006;Kalarchian et al 2007;Mitchell et al 2012), and by the considerable number of patients who might show a suboptimal progression following surgery, both with regard to weight and in terms of somatic, psychological, and psychosocial parameters (e.g., adherence to follow-up examinations to detect, among other things, vitamin and mineral deficiencies) as well as quality of life (QoL) on the other hand (Magro et al 2008;Mechanick et al 2013;O'Brien et al 2004;Odom et al 2010;Sjostrom et al 2007). In particular, the assumption of a causal relationship between preoperative mental disorders and postoperative course of body weight gave categorical diagnoses according to ICD/DSM (axis 1 and 2 disorders) a high predictive value.…”

“…The evidence concerning preoperative eating predictors of later weight appears to be limited and inconsistent. However, taken together, the results suggest that although links between pre-surgical binge eating and poorer post-surgical outcomes are less consistent (Niego et al 2007;Mechanick et al 2013), several review articles have found strong links between loss of control eating and BED after bariatric surgery and poorer weight loss or greater weight regain (Meany et al 2014;Sheets et al 2015). The relevance of postoperative eating disturbances becomes evident when studying the association of these behaviors with higher ratings on psychological distress and consequently reduced QoL (Colles et al 2008;Myers et al 2012).…”

Usefulness of an intra-gastric balloon before bariatric surgery

“…A 10% loss in body weight (10% TWL) will translate into a reduction of visceral, central and abdominal fat, as well as of liver size (12,13); there will be an improvement in associated comorbidities (4,14) and mortality (15).…”

Assessing Real World Effect of Laparoscopic Bariatric Surgery on Healthcare Costs- a Retrospective Matched Cohort Study using a U.S. Administrative Claims Database

“…[3][4][5] Bariatric surgery is considered an effective procedure for stimulating significant weight loss and improving obesityrelated co morbidities such as T2DM among severely obese persons. [2,6]However, in 2010 only 1% of persons clinically eligible for bariatric surgery received surgical treatment. [7] Using the Nationwide Inpatient Sample database, the number of bariatric surgeries performed in the U.S. from 2008 to 2012 was estimated at 598,576, with a rate in 2012 of51 surgeries per 100,000 people.…”

“…T2DM, dyslipidemia, hypertension) be considered eligible for bariatric surgery. [6]A Cochrane review of 22 randomized controlled trials with 1,798 participants reported that bariatric surgery was associated with greater improvement in weight loss outcomes and weight-associated co morbidities when compared with non-surgical interventions, regardless of the type of procedure used. [9]Bariatric surgery techniques have evolved over the last decade and the majority are performed using the laparoscopic approach, which is associated with shorter hospital stays and lower complication rates than open gastric bypass.…”