Clinical obesityDec 14, 2024

International expert agreement on how patients should prepare for weight loss surgery

Updated Mar 1, 2026

Abstract

Consensus was achieved on 90 of 169 statements (53.3%) regarding perioperative management in metabolic and bariatric surgery.

Varying eligibility criteria for metabolic and bariatric surgery may impact patient care and healthcare resources.
Updated 2022 guidelines aim to standardise indications for surgery and emphasise the importance of thorough preoperative assessments.
The study involved 45 global experts and utilized a two-round Delphi protocol to gather consensus.
Key areas of agreement included multidisciplinary team composition, patient selection criteria, preoperative testing, and referral pathways.
The findings highlight the significance of integrating healthcare professionals in the perioperative management of metabolic and bariatric surgery.

Simplified

Global obesity rates have risen dramatically, now exceeding deaths from starvation. Metabolic and bariatric surgery (MBS), initially for severe obesity (BMI ≥35 kg/m), is performed globally over 500 000 times annually, offering significant metabolic benefits beyond weight loss. However, varying eligibility criteria globally impact patient care and healthcare resources. Updated in 2022, ASMBS and IFSO guidelines aim to standardise MBS indications, reflecting current understanding and emphasising comprehensive preoperative assessments. Yet, clinical variability persists, necessitating consensus-based recommendations. This modified Delphi study engaged 45 global experts to establish consensus on perioperative management in MBS. Experts selected from bariatric societies possessed expertise in MBS and participated in a two-round Delphi protocol. Consensus was achieved on 90 of 169 statements (53.3%), encompassing multidisciplinary team composition, patient selection criteria, preoperative testing, and referral pathways. The agreement highlighted the critical role of comprehensive preoperative assessments and the integration of healthcare professionals in MBS. These findings offer essential insights to standardise perioperative practices and advocate for evidence-based guidelines in MBS globally. The study underscores the need for unified protocols to optimise outcomes and guide future research in MBS. 2

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