Mohammad Kermansaravi, Sonja Chiappetta, Chetan Parmar, Scott A. Shikora, Gerhard Prager, Teresa LaMasters, Jaime Ponce, Lilian Kow, Abdelrahman Nimeri, Shanu N. Kothari, Edo Aarts, Syed Imran Abbas, Ahmad Aly, Ali Aminian, Ahmad Bashir, Estuardo Behrens, Helmuth Billy, Miguel A. Carbajo, Benjamin Clapp, Jean-Marc Chevallier, Ricardo V. Cohen, Jerome Dargent, Bruno Dillemans, Silvia L. Faria, Manoel Galvao Neto, Pierre Y. Garneau, Khaled Gawdat, Ashraf Haddad, Mohamad Hayssam ElFawal, Kelvin Higa, Jaques Himpens, Farah Husain, Matthew M. Hutter, Kazunori Kasama, Radwan Kassir, Amir Khan, Mousa Khoursheed, Matthew Kroh, Marina S. Kurian, Wei-Jei Lee, Ken Loi, Kamal Mahawar, Corrigan L. McBride, Hazem Almomani, John Melissas, Karl Miller, Monali Misra, Mario Musella, C. Joe Northup, Mary O’Kane, Pavlos K. Papasavas, Mariano Palermo, Richard M. Peterson, Ralph Peterli, Luis Poggi, Janey S. A. Pratt, Aayad Alqahtani, Almino C. Ramos, Karl Rheinwalt, Rui Ribeiro, Ann M. Rogers, Bassem Safadi, Paulina Salminen, Sergio Santoro, Nathaniel Sann, John D. Scott, Asim Shabbir, Stephanie Sogg, Erik Stenberg, Michel Suter, Antonio Torres, Surendra Ugale, Ramon Vilallonga, Cunchuan Wang, Rudolf Weiner, Natan Zundel, Luigi Angrisani, and Maurizio De Luca
Abstract Metabolic and bariatric surgery (MBS) is widely considered the most effective option for treating obesity, a chronic, relapsing, and progressive disease. Recently, the American Society of Metabolic and Bariatric Surgery (ASMBS) and the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) issued new guidelines on the indications for MBS, which have superseded the previous 1991 National Institutes of Health guidelines. The aim of this study is to establish the first set of consensus guidelines for selecting procedures in Class I and II obesity, using an Expert Modified Delphi Method. In this study, 78 experienced bariatric surgeons from 32 countries participated in a two-round Modified Delphi consensus voting process. The threshold for consensus was set at an agreement or disagreement of ≥ 70.0% among the experts. The experts reached a consensus on 54 statements. The committee of experts reached a consensus that MBS is a cost-effective treatment option for Class II obesity and for patients with Class I obesity who have not achieved significant weight loss through non-surgical methods. MBS was also considered suitable for patients with Type 2 diabetes mellitus (T2DM) and a body mass index (BMI) of 30 kg/m2 or higher. The committee identified intra-gastric balloon (IGB) as a treatment option for patients with class I obesity and endoscopic sleeve gastroplasty (ESG) as an option for patients with class I and II obesity, as well as for patients with T2DM and a BMI of ≥ 30 kg/m2. Sleeve gastrectomy (1) and Roux-en-Y gastric bypass (RYGB) were also recognized as viable treatment options for these patient groups. The committee also agreed that one anastomosis gastric bypass (OAGB) is a suitable option for patients with Class II obesity and T2DM, regardless of the presence or severity of obesity-related medical problems. The recommendations for selecting procedures in Class I and II obesity, developed through an Expert Modified Delphi Consensus, suggest that the use of standard primary bariatric endoscopic (IGB, ESG) and surgical procedures (SG, RYGB, OAGB) are acceptable in these patient groups, as consensus was reached regarding these procedures. However, randomized controlled trials are still needed in Class I and II Obesity to identify the best treatment approach for these patients in the future.