WLS Guidelines and patient Selection

August 13, 2005

The following text is from Gastrointestinal Surgery for Severe

Obesity. NIH Consensus Statement 1991 Mar 25-27;9(1):1-20.

PATIENT SELECTION

These surgical procedures are major operations with short- and long-

term complications, some of which remain to be completely

elucidated. There are insufficient data on which to base

recommendations for patient selection using objective clinical

features alone. However, while data accumulate, it may be possible

in certain cases to consider surgery on the basis of limited

information from the uncontrolled or short-term followup studies

available. A decision to use surgery requires assessing the risk-

benefit ratio in each case. Those patients judged by experienced

clinicians to have a low probability of success with nonsurgical

measures, as demonstrated for example by failures in established

weight control programs or reluctance by the patient to enter such a

program, may be considered for surgery.

A gastric restrictive or bypass procedure should be considered only

for well-informed and motivated patients with acceptable operative

risks. The patient should be able to participate in treatment and

long-term followup.

Patients whose BMI exceeds 40 are potential candidates for surgery

if they strongly desire substantial weight loss, because obesity

severely impairs the quality of their lives. They must clearly and

realistically understand how their lives may change after operation.

In certain instances less severely obese patients (with BMI's

between 35 and 40) also may be considered for surgery. Included in

this category are patients with high-risk comorbid conditions such

as life-threatening cardiopulmonary problems (e.g., severe sleep

apnea, Pickwickian syndrome, and obesity-related cardiomyopathy) or

severe diabetes mellitus. Other possible indications for patients

with BMI's between 35 and 40 include obesity-induced physical

problems interfering with lifestyle (e.g., joint disease treatable

but for the obesity, or body size problems precluding or severely

interfering with employment, family function, and ambulation).

Children and adolescents have not been sufficiently studied to allow

a recommendation for surgery for them even in the face of obesity

associated with BMI over 40.

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