Jeffrey I Mechanick1, Caroline Apovian2, Stacy Brethauer3, W Timothy Garvey4, Aaron M Joffe5, Julie Kim6, Robert F Kushner7, Richard Lindquist8, Rachel Pessah-Pollack9, Jennifer Seger10, Richard D Urman11, Stephanie Adams12, John B Cleek13, Riccardo Correa14, M Kathleen Figaro15, Karen Flanders16, Jayleen Grams17, Daniel L Hurley18, Shanu Kothari19, Michael V Seger20, Christopher D Still21. 1. Marie-Josée and Henry R. Kravis Center for Clinical Cardiovascular Health at Mount Sinai Heart, New York, New York; Metabolic Support Divisions of Cardiology and Endocrinology, Diabetes, and Bone Disease, Icahn School of Medicine at Mount Sinai, New York, New York. Electronic address: jeffreymechanick@gmail.com. 2. Nutrition and Weight Management, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts. 3. Ohio State University, Columbus, Ohio. 4. Department of Nutrition Sciences, Birmingham VA Medical Center, Birmingham, Alabama; UAB Diabetes Research Center, University of Alabama at Birmingham, Birmingham, Alabama. 5. University of Washington, Harborview Medical Center, Seattle, Washington. 6. Harvard Medical School, Mount Auburn Hospital, Cambridge, Massachusetts. 7. Northwestern University Feinberg School of Medicine, Chicago, Illinois. 8. Providence Health Services, Seattle, Washington. 9. Division of Endocrinology, Diabetes and Metabolism, NYU Langone Health, New York, New York. 10. Department of Family and Community Medicine, Long School of Medicine, UT Health Science Center, San Antonio, Texas. 11. Brigham and Women's Hospital, Boston, Massachusetts. 12. American Association of Clinical Endocrinologists, Jacksonville, Florida. 13. Department of Nutrition Sciences, Birmingham VA Medical Center, Birmingham, Alabama. 14. University of Arizona College of Medicine, Phoenix, Arizona. 15. Heartland Endocrine Group, Davenport, Iowa. 16. Massachusetts General Hospital Weight Center, Boston, Massachusetts. 17. Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama; Birmingham VA Medical Center, Birmingham, Alabama. 18. Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, Minnesota. 19. Gundersen Health System, La Crosse, Wisconsin. 20. Bariatric Medical Institute of Texas, San Antonio, Texas, University of Texas Health Science Center, Houston, Texas. 21. Center for Nutrition and Weight Management Director, Geisinger Obesity Institute, Danville, Pennsylvania; Employee Wellness, Geisinger Health System, Danville, Pennsylvania.
Abstract
OBJECTIVE: The development of these updated clinical practice guidelines (CPG) was commissioned by the American Association of Clinical Endocrinologists, The Obesity Society, the American Society of Metabolic and Bariatric Surgery, the Obesity Medicine Association, and the American Society of Anesthesiologists boards of directors in adherence to the American Association of Clinical Endocrinologists 2017 protocol for standardized production of CPG, algorithms, and checklists. METHODS: Each recommendation was evaluated and updated based on new evidence from 2013 to the present and subjective factors provided by experts. RESULTS: New or updated topics in this CPG include contextualization in an adiposity-based, chronic disease complications-centric model, nuance-based, and algorithm/checklist-assisted clinical decision-making about procedure selection, novel bariatric procedures, enhanced recovery after bariatric surgery protocols, and logistical concerns (including cost factors) in the current healthcare arena. There are 85 numbered recommendations that have updated supporting evidence, of which 61 are revised and 12 are new. Noting that there can be multiple recommendation statements within a single numbered recommendation, there are 31 (13%) Grade A, 42 (17%) Grade B, 72 (29%) Grade C, and 101 (41%) Grade D recommendations. There are 858 citations, of which 81 (9.4%) are evidence level (EL) 1 (highest), 562 (65.5%) are EL 2, 72 (8.4%) are EL 3, and 143 (16.7%) are EL 4 (lowest). CONCLUSIONS: Bariatric procedures remain a safe and effective intervention for higher-risk patients with obesity. Clinical decision-making should be evidence-based within the context of a chronic disease. A team approach to perioperative care is mandatory with special attention to nutritional and metabolic issues.
OBJECTIVE: The development of these updated clinical practice guidelines (CPG) was commissioned by the American Association of Clinical Endocrinologists, The Obesity Society, the American Society of Metabolic and Bariatric Surgery, the Obesity Medicine Association, and the American Society of Anesthesiologists boards of directors in adherence to the American Association of Clinical Endocrinologists 2017 protocol for standardized production of CPG, algorithms, and checklists. METHODS: Each recommendation was evaluated and updated based on new evidence from 2013 to the present and subjective factors provided by experts. RESULTS: New or updated topics in this CPG include contextualization in an adiposity-based, chronic disease complications-centric model, nuance-based, and algorithm/checklist-assisted clinical decision-making about procedure selection, novel bariatric procedures, enhanced recovery after bariatric surgery protocols, and logistical concerns (including cost factors) in the current healthcare arena. There are 85 numbered recommendations that have updated supporting evidence, of which 61 are revised and 12 are new. Noting that there can be multiple recommendation statements within a single numbered recommendation, there are 31 (13%) Grade A, 42 (17%) Grade B, 72 (29%) Grade C, and 101 (41%) Grade D recommendations. There are 858 citations, of which 81 (9.4%) are evidence level (EL) 1 (highest), 562 (65.5%) are EL 2, 72 (8.4%) are EL 3, and 143 (16.7%) are EL 4 (lowest). CONCLUSIONS: Bariatric procedures remain a safe and effective intervention for higher-risk patients with obesity. Clinical decision-making should be evidence-based within the context of a chronic disease. A team approach to perioperative care is mandatory with special attention to nutritional and metabolic issues.
Authors: Leah M Schumacher; J Graham Thomas; Sivamainthan Vithiananthan; Jennifer Webster; Daniel B Jones; Dale S Bond Journal: Surg Obes Relat Dis Date: 2019-12-24 Impact factor: 4.734
Authors: Max M Puthenpura; Vishal Patel; John Fam; Leon Katz; David S Tichansky; Stephan Myers Journal: Obes Surg Date: 2020-09-26 Impact factor: 4.129
Authors: Nawfal W Istfan; Marine Lipartia; Wendy A Anderson; Donald T Hess; Caroline M Apovian Journal: J Clin Endocrinol Metab Date: 2021-01-01 Impact factor: 5.958
Authors: Susan K Raatz; LuAnn K Johnson; Alicia Caliquary; Wendy C King; Melissa A Kalarchian; Michael J Devlin; Marsha D Marcus; James E Mitchell Journal: Surg Obes Relat Dis Date: 2020-04-22 Impact factor: 4.734
Authors: Carrie-Anne Lewis; Susan de Jersey; Matthew Seymour; George Hopkins; Ingrid Hickman; Emma Osland Journal: Obes Surg Date: 2020-08-12 Impact factor: 4.129