Introduced in 2022 that is the International Federation for surgery for obesity and metabolic surgery this has great impact on the patients who Avail this treatment but also on the GPS and Specialists who actually prescribe this treatment and put their patients through the procedures so what were the guidelines in 1991 it mandated that the patients needed to have serious attempts at Medical Weight Loss before embarking on surgery they needed to be a BMI or a body mass index of more than 35 with some comorbidities or medical issues such as high blood pressure sleep apnea or diabetes or they needed to have a BMI of more than 40. there were no special considerations for specific medical conditions such as transplant or any other bigger surgeries that needed to be done as and they were not able to be done because of obesity.

So what if so did was they looked at all the literature and the research that was published in the last three decades and came up with recommendations not only with regards to the procedure type but also the indications for the bariatric surgery as well as expanded indications and one of them being the age limit cut off the current practice shows that majority of the procedures that are being done are laparoscopic sleeve gastrectomy or laparoscopic rho and Y gastric bypass then can pass about 90 percent of the practice the others include one anastomosis gastric bypass which is gaining traction especially in Australia and billiopancreatic diversion or the ordinal switch which is mainly popular in Europe and U.S the historic procedures which are not done anymore or very rarely seen are vertical Bond gastroplasty and laparoscopic adjustable gastric band mainly because of the complications involved with those so what are the new guidelines say if a patient weighs more than or if a patient has a BMI of more than 30 and has a comorbidity or a medical issue such as diabetes sleep apnea high blood pressure they qualify for bariatric surgery or if a patient is more than 35 BMI with or without any of these medical conditions they qualify for bariatric surgery in terms of the BMI cutoff it has been reduced for Asian population and anywhere compile the BMI of 27.5 is considered as overweight in Asian population and above the BMI of 32.5 is considered as obese in terms of the expanded indications the age limit doesn’t exist anymore largely speaking anybody over the age of 70 is still eligible for bariatric surgery as long as the risks can benefit is weighed out properly and the Frailty has been assessed that is they have been deemed fit for surgery because obesity is a major surgery and it needs to be dealt in such manner in terms of the children and adolescents if they have a BMI of more than 120 percent of the 95th percentile for their age and have one or two medical issues such as again diabetes high blood pressure a kidney disorders heart disorders or sleep apnea they qualify for the surgery or if they have a BMI of more than 140 percent of the 95th percentile for their age without even having any of the comorbidities or medical issues they qualify for surgery the new indications that have been put forth is in relation to major surgeries that wouldn’t have been done because of the Obesity and they were difficult to be done or they had bad outcomes and they include joint surgery and it mandates that the Obesity surgery needs to be done at least about a couple of years prior to considering joint surgery to have the best outcome the other two areas where obesity surgery will have a positive outcome leading to major surgeries are abdominal wall hernias or otherwise called as bental hernias and transplantations now all these expanded indications need to be considered carefully these need to be embarked on in a multi-disciplinary team approach and in a tertiary Center ideally where you have support of other Physicians and other Specialists especially when it comes to patients who are being put forth for transplant and they need bariatric surgery but at the same time expectations need to be set because a certain BMI requested by a specialist may or may not be achieved following bariatric surgery so the other expanded conditions or where the research shows that bariatric surgery is still helpful and relatively safe is in patients who weigh or has a BMI of more than 60 patients who have liver disorders such as cirrhosis and patients who are on the waiting list or for heart transplant who have a artificial heart to keep them alive again all these need to be taken into consideration after assessment by multiple Specialists rather than just considering the bariatric surgery on its own finally surgery and lifestyle together is what leads to success surgery our bariatric surgery is a tool that we can use or misuse but ideally if we use it in conjunction with alteration of our lifestyle it leads to the best outcome.