In 1991 a consensus conference was held at the National Institutes of Health (NIH) to discuss the role of gastrointestinal surgery in the management of the severely obese patient. The criteria are based on balancing the potential benefits of surgery and its considerable risks.


Parameters used to determine if a patient is a candidate for surgical management:

(1) body mass index

(2) severe comorbid conditions

(3) trial of nonsurgical management prior to surgery

(4) ability to tolerate surgery without excessive risk

(5) appropriate understanding of life changes following surgery and willingness to comply with postoperative regimen


A patient is a candidate for gastrointestinal surgery if:

(1) BMI > 40 kg per meter squared, OR

(2) BMI 35 to 40 kg per meter squared AND one or more serious comorbid conditions are present


Comorbid conditions associated with obesity:

(1) severe diabetes mellitus

(2) hypertension

(3) severe lipid disorders

(4) severe sleep apnea

(5) obesity-associated hypoventilation

(6) obesity-related cardiomyopathy

(7) physical problems (severe joint disease treatable after weight loss)

(8) significant socioeconomic or psychosocial impairment caused by the obesity


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