The 2022 ASMBS/IFSO statement updated general indications for metabolic and bariatric surgery. These criteria support referral and assessment; they do not prove that SASI is the right procedure for an individual.
01 — GENERAL GUIDANCE
When is bariatric surgery considered?
Surgery is recommended
Metabolic and bariatric surgery is recommended regardless of the presence, absence, or severity of obesity-related conditions.
It may be considered
Assessment may be appropriate with metabolic disease or when non-surgical treatment has not produced substantial, durable improvement.
Metabolic context matters
Duration, medicines, pancreatic reserve, current control, and complications may affect expected benefit.
Source: 2022 ASMBS/IFSO indications statement. Countries, health systems, and insurers may apply different referral or coverage rules.
02 — MULTIDISCIPLINARY ASSESSMENT
What should be assessed before surgery?
Medical health
Diabetes, blood pressure, sleep apnoea, fatty liver disease, heart and lung risk, medicines, and causes of weight gain.
Nutrition
Eating pattern, protein intake, existing deficiencies, gastrointestinal symptoms, and ability to follow the post-operative plan.
Mental health
Eating disorders, substance use, depression or anxiety, realistic expectations, coping, and social support.
Anatomy and surgery history
Endoscopy, reflux, previous abdominal or bariatric surgery, and technical feasibility.
Life plans
Pregnancy intentions, work, medicine absorption, and reliable access to appointments, tests, and supplements.
Alternatives
Intensive lifestyle support, anti-obesity medicines, and other operations compared using the individual risk-benefit profile.
03 — PREPARATION
Sometimes the safest decision is to prepare first.
Active substance-use disorder, an uncontrolled severe psychiatric condition, untreated eating disorder, pregnancy, correctable severe nutrient deficiency, unacceptable anaesthetic risk, or no safe follow-up plan may require surgery to be delayed. Delay is not always permanent; reassessment may follow appropriate treatment or stabilisation.
04 — CONSULTATION CHECKLIST
Take these questions to your first appointment.
01Why are you recommending SASI for my health history and goals?
02How do sleeve, Roux-en-Y, OAGB, SADI-S, and medication compare for me?
03How much experience does your team have with SASI and its revisions?
04How does your centre track leaks, bleeding, readmission, and revision?
05What is my nutrition and laboratory follow-up schedule, and who coordinates it?
06Who do I contact 24/7 if I develop an urgent symptom?
07What costs include follow-up, tests, supplements, and possible additional care?
08What is the plan if weight loss is inadequate or a complication develops?