Six conditions are required to benefit from bariatric surgery:
- BMI ≥ 40 kg/m2 OR BMI ≥ 30 to 40 kg/m2
with at least one comorbidity that is likely to improve following surgery (high blood pressure, obstructive sleep apnoea syndrome, type 2 diabetes, incapacitating joint disorders, non-alcoholic steatohepatitis, etc.)
- failure of medical, nutritional, dietetic and psychotherapeutic treatment that has been properly conducted for six to 12 months (weight loss is not sufficient or weight loss is not maintained)
- multidisciplinary preoperative assessment and management for several months
- patient is well informed
- patient has understood and accepted the need for lifelong surgical and medical follow-up
- acceptable operating risk.
Contraindications, some of which may be temporary:
- severe cognitive or mental disorders
- severe and non-stabilised eating disorders
- alcohol or psychoactive substances dependence
- diseases that are life-threatening in the short and medium term
- contraindications to general anaesthesia
- absence of identified prior medical management of obesity and likely inability of the patient to participate in lifelong medical follow-up
Preoperative medical, psychological and educational management for several months is necessary:
- assessment and management of comorbidities (high blood pressure, obstructive sleep apnoea syndrome, type 2 diabetes, incapacitating joint disorders, non-alcoholic steatohepatitis, etc.), assessment of eating behaviour and management of any eating disorder, nutritional and vitamin assessment and correction of any deficits, upper gastrointestinal endoscopy with tests for Helicobacter pylori
- psychological/psychiatric assessment: for all patients who are candidates for obesity surgery
- therapeutic education programme : diet and physical exercise.
Deciding to Operate
A decision is made following multidisciplinary medical and surgical discussion and consensus that may involve the general practitioner.
Surgery can dramatically improve quality of life and improve medical conditions associated with obesity.
Perioperative Safety in the Longitudinal Assessment of Bariatric Surgery
New England Journal of Medicine 2009;361:445-54.
Quality of Life Outcomes of Bariatric Surgery: A Systematic Review.
Obesity Surgery2016 Feb; 26(2): 395-409