ASMBS updated position statement on bariatric surgery in class I obesity (BMI 30–35 kg/m2)

Aminian, Ali; Chang, Julietta; Brethauer, Stacy A.; Kim, Julie

doi:10.1016/j.soard.2018.05.025

Cited by 80 publications

(68 citation statements)

References 90 publications

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“…While some authors argue that NAFLD should be considered a comorbidity that lowers the BMI threshold for metabolic surgery to 35 kg/m 2 [ 168 ], the American Society for Metabolic and Bariatric Surgery recommends that surgical treatment should be offered as an option for suitable patients with BMI 30–35 kg/m 2 and obesity related co-morbidities, including NAFLD, who do not achieve substantial, durable weight loss and co-morbidity improvement with reasonable nonsurgical methods [ 169 ].…”

Section: Nafld Treatmentmentioning

confidence: 99%

NAFLD as a continuum: from obesity to metabolic syndrome and diabetes

Godoy-Matos

Júnior

Valério

2020

Diabetol Metab Syndr

439

287

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Background: The prevalence of non-alcoholic fatty liver disease (NAFLD) has been increasing rapidly. It is nowadays recognized as the most frequent liver disease, affecting a quarter of global population and regularly coexisting with metabolic disorders such as type 2 diabetes, hypertension, obesity, and cardiovascular disease. In a more simplistic view, NAFLD could be defined as an increase in liver fat content, in the absence of secondary cause of steatosis. In fact, the clinical onset of the disease is a much more complex process, closely related to insulin resistance, limited expandability and dysfunctionality of adipose tissue. A fatty liver is a main driver for a new recognized liver-pancreatic α-cell axis and increased glucagon, contributing to diabetes pathophysiology. Main text: This review will focus on the clinical and pathophysiological connections between NAFLD, insulin resistance and type 2 diabetes. We reviewed non-invasive methods and several scoring systems for estimative of steatosis and fibrosis, proposing a multistep process for NAFLD evaluation. We will also discuss treatment options with a more comprehensive view, focusing on the current available therapies for obesity and/or type 2 diabetes that impact each stage of NAFLD. Conclusion: The proper understanding of NAFLD spectrum-as a continuum from obesity to metabolic syndrome and diabetes-may contribute to the early identification and for establishment of targeted treatment.

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Section: Nafld Treatmentmentioning

confidence: 99%

NAFLD as a continuum: from obesity to metabolic syndrome and diabetes

Godoy-Matos

Júnior

Valério

2020

Diabetol Metab Syndr

439

287

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“…On the basis of this mounting evidence, several organizations and government agencies have recommended expanding the indications for metabolic surgery to include patients with type 2 diabetes who do not achieve durable weight loss and improvement in comorbidities (including hyperglycemia) with reasonable nonsurgical methods at BMIs as low as 30 kg/m 2 (27.5 kg/m 2 for Asian Americans) (54)(55)(56)(57)(58)(59)(60)(61). Please refer to "Metabolic Surgery in the Treatment Algorithm for Type 2 Diabetes: A Joint Statement by International Diabetes Organizations" for a thorough review (17).…”

Section: 16mentioning

confidence: 99%

8. Obesity Management for the Treatment of Type 2 Diabetes:Standards of Medical Care in Diabetes—2019

2018

Diabetes Care

134

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The American Diabetes Association (ADA) "Standards of Medical Care in Diabetes" includes ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations, please refer to the Standards of Care Introduction. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC. There is strong and consistent evidence that obesity management can delay the progression from prediabetes to type 2 diabetes (1-5) and is beneficial in the treatment of type 2 diabetes (6-17). In patients with type 2 diabetes who are overweight or obese, modest and sustained weight loss has been shown to improve glycemic control and to reduce the need for glucose-lowering medications (6-8). Small studies have demonstrated that in patients with type 2 diabetes and obesity, more extreme dietary energy restriction with very low-calorie diets can reduce A1C to ,6.5% (48 mmol/mol) and fasting glucose to ,126 mg/dL (7.0 mmol/L) in the absence of pharmacologic therapy or ongoing procedures (10,18,19). Weight lossinduced improvements in glycemia are most likely to occur early in the natural history of type 2 diabetes when obesity-associated insulin resistance has caused reversible b-cell dysfunction but insulin secretory capacity remains relatively preserved (8,11,19,20). The goal of this section is to provide evidence-based recommendations for weight-loss therapy, including diet, behavioral, pharmacologic, and surgical interventions, for obesity management as treatment for hyperglycemia in type 2 diabetes. ASSESSMENT Recommendation 8.1 At each patient encounter, BMI should be calculated and documented in the medical record. B At each routine patient encounter, BMI should be calculated as weight divided by height squared (kg/m 2) (21). BMI should be classified to determine the presence of overweight or obesity, discussed with the patient, and documented in the patient Suggested citation: American Diabetes Association. 8. Obesity management for the treatment of type 2 diabetes:

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“…Bariatric surgery in the last two decades has had a significant growth and development. The selection of the patient, the perioperative management and the postoperative follow-up together with the technological evolution of the equipment for laparoscopic surgery and the improvement in the staple material have made surgery a safe treatment that produces the greatest weight loss and improvement of comorbidities in patients with obesity [ 4 ].…”

Section: Discussionmentioning

confidence: 99%

“…The prevalence of obesity and Type 2 Diabetes Mellitus, not only reduced life expectancy, but has also increased financial burden [ 1 ]. Bariatric surgery has currently proven to be the only lasting way to treat obesity, and its primary objective is to attack the principal cause of an endless number of related secondary health problems, for example: type II diabetes, hypertension, metabolic syndrome, distress from sleep, gastroesophageal reflux disease, among others [ 3 , 5 , 4 , 8 ].…”

Section: Introductionmentioning

confidence: 99%

“…In Mexico, during 2016, the prevalence of overweight and obesity in children under five years was 6.1%, in school children 33.2%, in adolescents 33.6% and in adults 72.5% [ 1 , 2 ]. Obesity and its comorbidities have currently positioned themselves as one of the greatest challenges in the health and economic system worldwide, since not only decrease the quality and life expectancy of the population, but their care requires great amounts of economic, human and infrastructure resources, monopolizing a large percentage for health spending [ 4 , 5 ].…”

Section: Introductionmentioning

confidence: 99%

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