Pre-Bariatric Surgery Micronutrient Profile

Per 2019 guidelines,² bariatric surgery is advised under the following conditions in adult populations:

Patients with a body mass index ≥40 kg/m² without co-existing medical problems and for whom bariatric procedures would not be associated with excessive risk are eligible for a bariatric procedure (Grade A; BEL 1).

Patients with a body mass index (BMI) ≥35 kg/m² and one or more severe obesity-related complications remediable by weight loss, including type 2 diabetes (T2D), high risk for T2D (insulin resistance, prediabetes and/or metabolic syndrome), poorly controlled hypertension, nonalcoholic fatty liver disease/nonalcoholic steatohepatitis, obstructive sleep apnea, osteoarthritis of the knee or hip and urinary stress incontinence, should be considered for a bariatric procedure (Grade C; BEL 3).

Patients with the following comorbidities and BMI ≥35 kg/m² may also be considered for a bariatric procedure, hypoventilation syndrome and Pickwickian syndrome after a careful evaluation of operative risk: idiopathic intracranial hypertension; gastroesophageal reflux disease; severe venous stasis disease; impaired mobility due to obesity and considerably impaired quality of life (Grade C; BEL 3).

Patients with body mass index 30 to 34.9 kg/m² and type 2 diabetes with inadequate glycemic control despite optimal lifestyle and medical therapy should be considered for a bariatric procedure; current evidence is insufficient to support recommending a bariatric procedure in the absence of obesity (Grade B; BEL 2).

The body mass index criterion for bariatric procedures should be adjusted for ethnicity (e.g., 18.5 to 22.9 kg/m² is normal range, 23 to 24.9 kg/m² is overweight and ≥25 kg/m2 is obesity for Asians) (Grade D).

Bariatric procedures should be considered to achieve optimal outcomes regarding health and quality of life when the amount of weight loss needed to prevent or treat clinically significant ORC cannot be obtained using only structured lifestyle change with medical therapy (Grade B; BEL 2).

Grading of these guidelines corresponds to the following levels of recommendation (BEL: best evidence level):

• Grade A / BEL 1 – strong recommendation

• Grade B / BEL 2 – intermediate recommendation

• Grade C / BEL 3 – weak recommendation

• Grade D – no conclusive evidence or expert opinion

The following indications for bariatric surgery³ are suggested by the 2022 American Society for Metabolic and Bariatric Surgery (ASMBS) and International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO):

• Metabolic and bariatric surgery (MBS) is recommended for individuals with a body mass index (BMI) ≥35 kg/m², regardless of presence, absence or severity of co-morbidities.

• MBS should be considered for individuals with metabolic disease and BMI of 30-34.9 kg/m².

• BMI thresholds should be adjusted in the Asian population such that a BMI ≥25 kg/m² suggests clinical obesity, and individuals with BMI ≥ 27.5 kg/m² should be offered MBS.