Table 3.

Summary of bariatric surgery and obesity care related statements from professional organizations and National Institute of Health

Professional organization	Yr		Body mass index criteria	Statements regarding bariatric surgery and obesity care
American Diabetes Association (ADA) [30]	2017		≥40 kg/m2	“Metabolic surgery should be recommended to treat type 2 diabetes in appropriate surgical candidates regardless of the level of glycemic control or complexity of glucose-lowering regimens.”
			35–40 kg/m2	“Metabolic surgery should be recommended to treat type 2 diabetes in appropriate surgical candidates when hyperglycemia is inadequately controlled despite lifestyle and optimal medical therapy.”
			30–35 kg/m2	“Metabolic surgery should be considered for adults with type 2 diabetes if hyperglycemia is inadequately controlled despite optimal medical control by either oral or injectable medications.”
American Academy of Family Physicians (AAFP) [31]	2016		-	“Bariatric surgery results in greater weight loss than nonsurgical weight loss interventions. “ “Bariatric surgery is highly effective in treating obesity-related co-morbidities, particularly diabetes mellitus.” “Bariatric surgery reduces obesity-related mortality.”
American Heart Association (AHA)/American College of Cardiology (ACC)/The Obesity Society (TOS) [32]		2013	≥40 kg/m2 35–40 kg/m2 with obesity-related co-morbid conditions	“Advise adults who are motivated to lose weight and who have not responded to behavioral treatment with or without pharmacotherapy with sufficient weight loss to achieve targeted health outcome goals that bariatric surgery may be an appropriate option to improve health and offer referral to an experienced bariatric surgeon for consultation and evaluation.”
			<35 kg/m2	“Insufficient evidence to recommend for or against undergoing bariatric surgical procedures”
American Association of Clinical Endocrinologists(AACE)/TOS/American Society for Metabolic & Bariatric Surgery (ASMBS) [33]	2013		≥0 kg/m2 without coexisting medical problems	“Patients for whom bariatric surgery would not be associated with excessive risk should be should be offered bariatric surgery.”
			35–40 kg/m2 and one or more severe obesity- related co-morbidity	“...may also be offered a bariatric procedure”
			30–35 kg/m2 with diabetes or metabolic syndrome	“...may also be offered a bariatric procedure”
U.S. Preventative Services Task Force (USPSTF) [34]	2012		-	“Screen all adults for obesity”
			≥30 kg/m2	“Patients should be offered or referred to intensive, multicomponent behavioral interventions. “
American College of Physicians (ACP) [36]	2005		—	“Patients should be referred to high volume centers with surgeons experienced in bariatric surgery.”
			≥40 kg/m2 with obesity-related co-morbid conditions	“Surgery should be considered as a treatment option for patients who instituted but failed an adequate exercise and diet program (with or without adjunctive drug therapy). A doctor-patient discussion of surgical options should include the long-term side effects, such as possible need for reoperation, gall bladder disease, and malabsorption.”
National Institute of Health (NIH) [35]	1991		-	“Patients judged by experienced clinicians to have a low probability of success with nonsurgical measures may be considered for surgery. A gastric restrictive or bypass procedure should be considered only for well-informed and motivated patients in whom the operative risks are acceptable.”
			>40 kg/m2 35–40 kg/m2 with high risk co-morbid conditions or obesity-induced physical problems that interfere with lifestyle	“Patients are potential candidates for surgery if they strongly desire substantial weight loss, because obesity severely impairs the quality of their lives.” “. may also be considered for surgery”