The indication for obesity surgery is given if the goal of the procedure is a sustained reduction in weight. Type 2 diabetes mellitus may occur by chance but is not absolutely necessary for the indication of the procedure.
According to the current guideline "Surgery of Obesity and Metabolic Diseases" of the German Society for General and Visceral Surgery (status 2010), the indication is given under the following conditions:
- BMI ≥ 40 kg/m² without accompanying diseases - after exhaustion of the conservative treatment of obesity
- BMI ≥ 35 kg/m² with one or more obesity-related concomitant diseases such as diabetes mellitus type 2, coronary heart disease, cardiac insufficiency, lipometabolic disorders, high blood pressure, sleep apnoea syndrome, liver metabolic disorders, reflux disease, asthma, leg vein diseases, urinary bladder weakness, joint diseases, infertility - after exhaustion of the conservative treatment of obesity
- The indication can also be given without a previous conservative treatment attempt:
- BMI ≥ 50 kg/m²
- patients for whom a conservative therapy attempt was classified as unpromising or hopeless
- patients with particular severity of concomitant diseases that do not allow a delay in surgery
When is the conservative treatment of obesity considered to have failed?
According to the above guideline, conservative treatment measures are failed
- after at least 6 months of comprehensive lifestyle intervention in the last two years, a reduction of the initial weight of > 15% with a BMI of 35-39.9 kg/m² and > 20% with a BMI above 40 kg/m² has not been achieved.
- the above weight reduction could be achieved by conservative measures, but persisting obesity-related diseases can be further improved by the intervention
- after a successful weight reduction within one year a weight gain of > 10% takes place again
Bilbiography sources:
Buchwald H, Avidor Y, Braunwald E, Jensen MD, Pories W, Fahrbach K, Schoelles K. Bariatric surgery: a systematic review and meta-analysis. JAMA 2004;292(14):1724-37.
Christou NV, Sampalis JS, Liberman M, Look D, Auger S, McLean AP, MacLean LD. Surgery decreases long-term mortality, morbidity, and health care use in morbidly obese patients. Ann Surg 2004;240(3):416-23.
Colquitt JL, Picot J, Loveman E, Clegg AJ. Surgery for obesity. Cochrane Database Syst Rev 2009(2): CD003641.
Deutsche Gesellschaft für Allgemein- und Viszeralchirurgie, Chirurgische Arbeitsgemeinschaft für Adipositastherapie (CAADIP), Deutsche Adipositas-Gesellschaft (DAG), Deutsche Gesellschaft für Psychosomatische Medizin und Psychotherapie, Deutsche Gesellschaft für Ernährungsmedizin (2010) S3-Leitlinie: Chirurgie der Adipositas.
Dixon JB, Zimmet P, Alberti KG, Rubino F. Bariatric surgery: an IDF statement for obese Type 2 diabetes. Diabet Med 2011;28(6):628-42.
Maggard MA, Shugarman LR, Suttorp M, Maglione M, Sugerman HJ, Livingston EH, Nguyen NT, Li Z, Mojica WA, Hilton L, Rhodes S, Morton SC, Shekelle PG. Metaanalysis: surgical treatment of obesity. Ann Intern Med 2005;142(7):547-59.
Runkel N, Colombo-Benkmann M, Huttl TP, Tigges H, Mann O, Flade-Kuthe R, Shang E, Susewind M, Wolff S, Wunder R, Wirth A, Winckler K, Weimann A, de ZM, Sauerland S. Evidence-based German guidelines for surgery for obesity. Int J Colorectal Dis 2011;26(4):397-404.
Schauer PR, Kashyap SR, Wolski K, Brethauer SA, Kirwan JP, Pothier CE, Thomas S, Abood B, Nissen SE, Bhatt DL. Bariatric surgery versus intensive medical therapy in obese patients with diabetes. N Engl J Med 2012;366(17):1567-76.
Sjostrom L, Lindroos AK, Peltonen M, Torgerson J, Bouchard C, Carlsson B, Dahlgren S, Larsson B, Narbro K, Sjostrom CD, Sullivan M, Wedel H. Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. N Engl J Med 2004;351(26):2683-93.
Sjostrom L, Narbro K, Sjostrom CD, Karason K, Larsson B, Wedel H, Lystig T, Sullivan M, Bouchard C, Carlsson B, Bengtsson C, Dahlgren S, Gummesson A, Jacobson P, Karlsson J, Lindroos AK, Lonroth H, Naslund I, Olbers T, Stenlof K, Torgerson J, Agren G, Carlsson LM. Effects of bariatric surgery on mortality in Swedish obese subjects. N Engl J Med 2007;357(8):741-52.
Slater GH, Ren CJ, Siegel N, Williams T, Barr D, Wolfe B, Dolan K, Fielding GA. Serum fat-soluble vitamin deficiency and abnormal calcium metabolism after malabsorptive bariatric surgery. J Gastrointest Surg 2004;8(1):48-55.
