Statement on Metabolic and Bariatric Surgery During COVID-19 Pandemic

Posted on Jun 24th, 2020

Newberry, Fla. — Jun. 23, 2020 —

The American Society for Metabolic and Bariatric Surgery (ASMBS), the leading organization of bariatric surgeons and integrated health professionals in the nation, declared metabolic and bariatric surgery "medically necessary and the best treatment for those with the life-threatening and life-limiting disease of severe obesity" and called for the safe and rapid resumption of procedures, which have been largely postponed along with other surgeries deemed elective amid the COVID-19 pandemic.

In a new position statement entitled, "Safer Through Surgery," published online in the journal SOARD, the ASMBS strongly rejects classifying metabolic and bariatric surgery as "elective" and prefers the use of the term "Medically Necessary Time-Sensitive Surgery" or "Medically Necessary Non-Emergent Surgery" to better characterize the effectiveness of the intervention and the progressive nature of the many diseases it treats including obesity, type 2 diabetes, hypertension and heart disease.

"COVID-19 may be a factor for quite some time and the longer the treatment of obesity, type 2 diabetes and other related diseases are postponed, the greater the chance they will become worse," said Matthew M. Hutter, MD, MPH, president of the ASMBS and professor of surgery at Harvard Medical School. "Each state, doctor and patient must make a decision as to when conditions for metabolic and bariatric surgery are right, but the sooner it can be safely performed, the more quickly obesity, type 2 diabetes and other diseases can be reduced or resolved."

The ASMBS recommends that the precise timing for surgery be carefully considered based on factors including an individual patient’s health status, local prevalence of COVID-19 and the availability of resources including hospital beds, ventilators and personal protective equipment (PPE).

The ASMBS statement concludes, "Before COVID-19 began, it was clear that patients with obesity were ‘safer through surgery’. In the era of COVID-19, ‘safer through surgery’ for patients with obesity may prove to be even more important than before." Obesity has been identified as an independent risk factor for adverse outcomes including death among COVID-19 patients.

Metabolic/bariatric surgery has been shown to be the most effective and long-lasting treatment for severe obesity. 1 Its safety profile is comparable to some of the safest and most commonly performed surgeries in the U.S. including gallbladder surgery, appendectomy and knee replacement. 2

An estimated 252,000 bariatric surgeries were performed in the United States in 2018, which is approximately less than 1 percent of the population eligible for surgery based on BMI. 3 The U.S. Centers for Disease Control and Prevention (CDC) reports 42.4 percent of Americans had obesity in 2017-2018. 4 Obesity has been linked to more than 40 diseases including type 2 diabetes, hypertension, heart disease, stroke, sleep apnea, osteoarthritis and at least 13 different types of cancer. 5,6,7

About the ASMBS

The ASMBS is the largest organization for bariatric surgeons in the nation. It is a non-profit organization that works to advance the art and science of bariatric surgery and is committed to educating medical professionals and the lay public about bariatric surgery as an option for the treatment of severe obesity, as well as the associated risks and benefits. It encourages its members to investigate and discover new advances in bariatric surgery, while maintaining a steady exchange of experiences and ideas that may lead to improved surgical outcomes for patients with severe obesity. For more information, visit www.asmbs.org.

1 Weiner, R. A., et al. (2010). Indications and principles of metabolic surgery. U.S. National Library of Medicine. 81(4) pp.379-394. https://www.ncbi.nlm.nih.gov/pubmed/20361370

2 Gastric Bypass is as Safe as Commonly Performed Surgeries. Health Essentials. Cleveland Clinic. Nov. 6, 2014. Accessed October 2017 https://health.clevelandclinic.org/2014/11/gastric-bypass-is-as-safe-as-commonly-performed-surgeries/

3 https://asmbs.org/resources/estimate-of-bariatric-surgery-numbers

4 https://www.cdc.gov/obesity/data/adult.html

5 The Effectiveness and Risks of Bariatric Surgery: An Updated Systematic Review and Meta-analysis, 2003-2012. Accessed from: https://jamanetwork.com/journals/jamasurgery/fullarticle/1790378

6 Steele CB, Thomas CC, Henley SJ, et al. Vital Signs: Trends in Incidence of Cancers Associated with Overweight and Obesity — United States, 2005-2014. MMWR Morb Mortal Wkly Rep2017;66:1052-1058. DOI: http://dx.doi.org/10.15585/mmwr.mm6639e1

7 Centers for Disease Control and Prevention. (2015) The Health Effects of Overweight and Obesity. Accessed from: https://www.cdc.gov/healthyweight/effects/index.html