Elsevier

Endocrine Practice

Volume 19, Issue 2, March–April 2013, Pages 337-372
Endocrine Practice

Aace/Tos/Asmbs Guidelines
Clinical Practice Guidelines For The Perioperative Nutritional, Metabolic, And Nonsurgical Support Of The Bariatric Surgery Patient2013 Update: Cosponsored By American Association Of Clinical Endocrinologists, The Obesity Society, And American Society For Metabolic & Bariatric Surgery

https://doi.org/10.4158/EP12437.GLGet rights and content

ABSTRACT

The development of these updated guidelines was commissioned by the AACE, TOS, and ASMBS Board of Directors and adheres to the AACE 2010 protocol for standardized production of clinical practice guidelines (CPG). Each recommendation was re-evaluated and updated based on the evidence and subjective factors per protocol. Examples of expanded topics in this update include: the roles of sleeve gastrectomy, bariatric surgery in patients with type-2 diabetes, bariatric surgery for patients with mild obesity, copper deficiency, informed consent, and behavioral issues. There are 74 recommendations (of which 56 are revised and 2 are new) in this 2013 update, compared with 164 original recommendations in 2008. There are 403 citations, of which 33 (8.2%) are EL 1, 131 (32.5%) are EL 2, 170 (42.2%) are EL 3, and 69 (17.1%) are EL 4. There is a relatively high proportion (40.4%) of strong (EL 1 and 2) studies, compared with only 16.5% in the 2008 AACETOS-ASMBS CPG. These updated guidelines reflect recent additions to the evidence base. Bariatric surgery remains a safe and effective intervention for select patients with obesity. A team approach to perioperative care is mandatory with special attention to nutritional and metabolic issues.

Section snippets

INTRODUCTION

Obesity continues to be a major public health problem in the United States, with more than one-third of adults considered obese in 2009-2010, as defined by a body mass index (BMI) >30 kg/m2 (1 [EL 3, SS]). Obesity has been associated with an increased hazard ratio for all-cause mortality (2[EL 3, SS]), as well as significant medical and psychological co-morbidity. Indeed, obesity is not only a chronic medical condition but should be regarded as a bona fide disease state (3 [EL 4, NE]).

Methods

The Boards of Directors for the American Association of Clinical Endocrinologists (AACE), The Obesity Society (TOS), and the American Society for Metabolic & Bariatric Surgery (ASMBS) approved this update of the 2008 AACE, TOS, and ASMBS Medical Guidelines for Clinical Practice for the Perioperative Nutritional, Metabolic, and Nonsurgical Support of the Bariatric Surgery Patient (2008 AACE-TOS-ASMBS CPG; 7). These CPG expired in 2011 per the National Guideline Clearinghouse (//www.guideline.gov/content.aspx?id=13022&search=bariatric+aace

Executive Summary

There are 74 recommendations in this 2013 update, compared with 164 original recommendations in 2008. There are 56 revised recommendations and 2 new recommendations (R30 and R59) in this 2013 update. Consensus among primary writers was obtained for each of the recommendations.

DISCLOSURES

Jeffrey I. Mechanick, MD: Abbott Nutrition, honoraria for lectures and program development. Daniel B. Jones, MD, MS: Allurion, consultant. W. Timothy Garvey, MD: Merck, speakers list; Daiichi-Sanyo, Vivus, Alkermes, Liposcience, Tethys Bioscience, advisory boards; Merck, Amylin, Weight Watchers, research. Scott Shikora, MD: Baxter Healthcare, consultant; EnteroMedics, consultant; GI Dynamics, stock options for previous consultant work. John B. Dixon, MBBS, PhD, FRACGP, FRCPEdin: Consultant for

ACKNOWLEDGEMENTS

Reviewers: Robin Blackstone, MD: Immediate Past President, ASMBS; George Blackburn, MD, PhD: CoChair, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA; Alan Garber, MD: Departments of Medicine, Biochemistry and Molecular Medicine and Molecular and Cellular Biology, Baylor College of Medicine, Houston, TX; David B. Sarwer, PhD: Professor of Psychology, Departments of Psychiatry and Surgery and Director, Clinical Services, Center for Weight and Eating Disorders, Perelman

DISCLAIMER

American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery Medical Guidelines for Clinical Practice are systematically developed statements to assist health-care professionals in medical decision making for specific clinical conditions. Most of the content herein is based on literature reviews. In areas of uncertainty, professional judgment was applied. These guidelines are a working document that reflects the state of the

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