New bariatric surgery guidelines promise preventative care, long-term benefits

For patients with severe obesity and related health issues, like diabetes and advanced cardiovascular disease, bariatric surgery is an increasingly popular option. Now, new guidelines are recommending the procedures become available to more patients who may need them.

“An important misconception — and consideration — is that bariatric surgery is for more than just weight loss,” said Jeffrey Friedman, M.D., director of bariatric surgery and assistant professor in the UF Department of Surgery. “First and foremost, it is a metabolic operation. It improves diabetes, hypertension, sleep apnea, and all kinds of comorbidities.”

In 2022, the American Diabetic Association released new recommendations for patients with type two diabetes and lower body mass indexes, or BMIs, which measure a percentage of body fat based on a person’s height and weight and remain one of several important screening criteria for the procedures.

Historically, the BMI cutoff was 35. Now, however, bariatric surgeons are recommending that patients with a BMI of 30 or higher and uncontrolled diabetes, which is defined as an A1C of 7.5 or more, be considered for metabolic surgery.

“These changes [to surgery guidelines] are largely due to the consequent improvement and possible resolution of these patients’ diabetes,” Friedman explained.

In certain ethnicities, the BMI-related guidelines were lower — about 27.5 for BMI cutoff.

“Now we’re seeing this surgical specialty kind of transition from a weight loss bariatric surgery to more of a metabolic one to address conditions like diabetes, high blood pressure, and that sort of thing,” Friedman said.

Obesity is a nationwide disease, and a chronic one, Friedman pointed out. It is also progressive — meaning it typically worsens as patients age. Almost 98% of the time, lifestyle changes like diet and exercise fail as long- term sustainable weight loss solutions. In fact, between 30 and 40% of the population in the United States is now obese. This includes children as well as adults, Friedman said.

“When you gain weight and develop obesity, it’s not just obesity alone,” he pointed out. “It comes with everything from sleep apnea, to diabetes, to thyroid problems, heartburn, reflux, hypertension, high cholesterol, heart problems, back and joint pain, all kinds of problems.”

Friedman, whose clinical interests include the metabolic and cognitive effects of bariatric surgery, as well as its long-term effects, explains that weight loss surgeries can extend life expectancy by 20 years, help prevent the development of certain cancers, and assist patients in needing fewer daily medications.

“All of this improves patient outcomes and makes patients healthier as a whole,” Friedman said. “It can even save insurance companies money after a year or two as patients are needing fewer hospital visits, taking less time off from work, and not needing to visit the emergency room. All in all, they feel better — and that is always an outcome we strive to make happen.”