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New BMI guidelines expand patients' eligibility for bariatric surgery

New BMI guidelines expand patients' eligibility for bariatric surgery


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By 2035, more than half (51%) of the world's population—or more than four billion people—will be overweight or obese, according to the World Obesity Federation's 2023 atlas. The report, published earlier this March, contains other shocking statistics reflecting the millions of deaths and billions of dollars in annual healthcare costs associated with obesity. To address and begin to reverse the direction of this preventable health crisis, the World Health Organization (WHO) is urging all countries to take immediate and significant action.

"Obesity is a worldwide problem, it continues to be worse, and it is one of the major health issues that we must contend with," said Eric T. Volckmann, MD, the director of University of Utah Health's Bariatric Surgery Program. "So that is why there is so much interest in it medically and surgically."

One in four individuals living in Utah struggles with obesity. Volckmann would like to see that number lowered, and he believes it is now an attainable goal for the state. After more than three decades, guidelines that expand the requirements for a person to be eligible for bariatric surgery were published late last year. The new guidance also includes recommendations for children and adolescents to be considered for weight-loss surgery under certain conditions.

In 1991, these surgeries were confined to adult patients with a body mass index (BMI) of at least 40 or a BMI of 35 with at least one weight-related medical condition like high blood pressure or diabetes. In October 2022, the American Society for Metabolic and Bariatric Surgery (ASMBS) and the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) significantly lowered the BMI threshold at which surgery should be considered. These organizations now recommend anyone with a BMI of 35—or anyone with a BMI of 30 and health issues related to obesity— consider surgery and also think about having gastric bypass or the sleeve gastrectomy procedure.

Volckmann said the new guidelines make a lot of sense. "One of the main reasons why we see the BMI criteria shifting down is because we see the long-term effects of obesity on health and quality of life and the risk benefit range has changed over the past 20 years," Volckmann said. "Now, weight-loss surgery is a much safer procedure to do. It still must be done responsibly and with good patient selection."

Almost two years ago, Volckmann performed gastric bypass surgery on DeAnn Barfuss. She described her weight-loss journey as an emotionally rewarding one. "It has been a hard road, but it has been the best thing I ever did for myself. I wish I would have done it sooner. That is the only regret I have, but I wasn't ready sooner. It was a huge step." Eight months after her operation, Barfuss lost 122 pounds and was feeling younger and more hopeful about the future.

"When I look at a picture of me before the surgery, it doesn't even look like me," she said. "I see how unhappy and miserable that woman was. I was living for other people. You know, my dad tells me now that he has never seen me this happy—ever! It is interesting because the first three or four months after surgery were rough."

Volckmann warned Barfuss, as he does all his patients, that the days and weeks after surgery can often be the most difficult. But he knows that where there is commitment to change, the results will be long-lasting.

"Overwhelmingly, we see that the patients who do the best and lose the most and keep it off are patients like DeAnn who have buy in," Volckmann said. "They track what they eat, and they increase their activity, and they make significant lifestyle changes. It may be that the surgery was the tool that got them to make that lifestyle change, but it is the ongoing lifestyle that they have that helps them to maintain the weight loss."

New BMI guidelines expand patients' eligibility for bariatric surgery
Photo: New Africa/Shutterstock.com

The success story Barfuss has been writing since 2021 is timely. It comes just as the new BMI guidance replaces more restrictive criteria for weight-loss surgery. It also helps dedicated professionals like Volckmann educate more obese Americans about the benefits of bariatric surgery.

"What has been nice to see in the 12 years that I have been here [at U of U Health] is the perceptions of weight loss surgery change," Volckmann said. "When people see folks like DeAnn make positive changes in their life that are associated with weight loss, they have a different understanding of the surgery. I wish more people could see how this operation helps our patients and makes them healthier."

Barfuss believes she has and will continue to improve every aspect of her life from the physical to the mental to the emotional changes she has made to her overall health. For her, gastric bypass surgery was never a cop-out, nor was obesity the way she chose to live her life. "[The surgery] is not an easy road or one for the faint of heart," she said. "I have heard people say, 'That's the easy way out,' but I say, 'Oh no, it isn't.' You must make some major internal changes, or you will be back to where you were before surgery. And as far as I am concerned, that is never happening to me."

For surgical subspecialists like Volckmann, the positive impact of his work can be witnessed for years after performing the weight-loss surgery. "We are following our patients long-term and watching them get better and healthier," Volckmann said. "It is really rewarding."

The opportunity to open up the option of bariatric surgery to more patients is an exciting one for Volckmann. "With gastric bypass surgery, virtually all our patients go on to say, 'Best decision I ever made' and would do it again, would recommend it to a friend, and wished they had done it earlier," he said. "So, for many patients, it is a tool to get them to where they want to be with their life. Depending on where patients' weights are, that may look very different for individual people."

For Barfuss, the results of gastric bypass surgery continue to enhance her life. She is one of those patients who has not only kept the weight off but also continues to support and advocate for others battling obesity. In fact, she said, "If I can convince someone to go into the bariatric surgery program and make this change, I guarantee it will be unbelievable how good you will feel on the other side."

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