With the increasing number of obese patients worldwide, metabolic and bariatric surgery (MBS) has quickly become an effective way to treat obesity and related metabolic diseases such as type 2 diabetes, hypertension, lipid abnormalities, etc. Although MBS has become an important part of general surgery, there is still controversy regarding the indications for MBS. In 1991, the National Institutes of Health (NIH) issued a statement on the surgical treatment of severe obesity and other related issues, which continues to be the standard for insurance companies, health care systems, and hospital selection of patients. The standard no longer reflects the best practice data and lacks relevance to today's modern surgeries and patient populations. After 31 years, in October 2022, the American Society for Metabolic and Bariatric Surgery (ASMBS) and the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO), the world's leading authorities on weight loss and metabolic surgery, jointly released new guidelines for MBS indications, based on increasing awareness of obesity and its comorbidities and the accumulation of evidence of obesity metabolic diseases. In a series of recommendations, the eligibility of patients for bariatric surgery has been expanded. Specific key updates include the following: (1) MBS is recommended for individuals with BMI≥35 kg/m2, regardless of the presence, absence, or severity of co-morbidities; (2) MBS should be considered for individuals with metabolic diseases and BMI 30.0-34.9 kg/m2; (3) the BMI threshold should be adjusted for the Asian population:: BMI≥25 kg/m2 suggest clinical obesity, and BMI ≥ 27.5 kg/m2 population should consider MBS; (4) Appropriately selected children and adolescents should be considered for MBS.
随着肥胖患者在全球范围内不断增加，减重代谢手术（MBS）快速成为治疗肥胖及相关代谢疾病（如2型糖尿病、高血压、血脂异常等）的有效途径，虽然MBS现在已经十分普遍，成为普通外科手术的重要组成部分，然而关于MBS适应证方面仍存在争议。1991年，美国国立卫生院（NIH）关于如何开展外科手术治疗严重肥胖等相关问题发布了一份声明，该声明迄今为止依然是保险公司、医保部门和医院选择手术患者的标准。时到如今，该标准已不再反映最佳实践数据，缺乏与当下手术和患者群体的相关性。时隔31年，2022年10月，基于对肥胖及其合并症认识的深入以及肥胖代谢疾病证据的积累，两个世界领先的减重和代谢手术权威组织——美国肥胖代谢外科学会（ASMBS）和国际肥胖代谢外科联盟（IFSO）联合发布了全新的MBS适应证指南，在一系列建议中，扩大了患者接受减肥手术的条件，具体重大更新有以下几点：（1）对于体质指数（BMI）≥35 kg/m2的人群，无论是否存在合并症、合并症的严重程度如何，都推荐进行MBS；（2）对于BMI 30~34.9 kg/m2合并肥胖相关疾病的人群，应考虑MBS；（3）亚洲人群应调整BMI阈值，BMI≥25 kg/m2提示临床肥胖，BMI≥27.5 kg/m2的人群应考虑MBS；（4）MBS的长期结果证明了其安全性和有效性；（5）适当筛选后的儿童或青少年应考虑MBS。.