Dissemination of the 2022 ASMBS and IFSO Guidelines for Bariatric Surgery: What Has Reached Primary Care Providers?

Only 1% of Americans eligible for metabolic and bariatric surgery (MBS) receive MBS. Prior studies have analyzed primary care provider (PCP) referral patterns and perceptions of MBS as a potential barrier to increasing MBS. However, less data exists regarding PCP knowledge of MBS indications and outcomes. Following the 2022 update to the indications for MBS by the ASMBS and IFSO, the number of eligible patients is only expected to increase. We evaluated PCP knowledge regarding the existence of the 2022 ASMBS and IFSO updated guidelines, MBS indications, and MBS outcomes. An 11-question survey was emailed to primary care residents, advanced practice providers, and faculty at a single institution. Of 151 surveys distributed, 39.7% responded (n = 60). 95% were unaware of the 2022 updated guidelines. On multiple choice questions, 16.3% correctly identified the average weight loss from MBS, and 46.8% correctly answered the diabetes remission rate following MBS. Trainee answers were not statistically significant from practicing PCPs. Fifteen respondents had referred a patient for MBS, but this subgroup did not perform significantly better on the assessment. A total of 72.3% of respondents reported inadequate MBS education during their training, and 85.1% were interested in additional education. We present the first assessment of PCP MBS knowledge since the release of the 2022 updated ASMBS and IFSO guidelines. This study indicates a gap in PCPs' knowledge regarding the updated guidelines and represents an opportunity for collaboration with our primary care colleagues to provide further MBS education.

Hulse J ，Slay R ，Bryant MK ，Byrne TK ，Pullatt R ... -  《-》

Indications and Coverage of Metabolic and Bariatric Surgery: A Worldwide IFSO Survey Comparing Different National Guidelines.

Knowing how metabolic and bariatric surgery (MBS) is indicated in different countries is essential information for the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO). To analyze the indications for MBS recommended by each of the national societies that comprise the IFSO and how MBS is financed in their countries. All IFSO societies were asked to fill out a survey asking whether they have, and which are their national guidelines, and if MBS is covered by their public health service. Sixty-three out of the 72 IFSO national societies answered the form (87.5%). Among them, 74.6% have some kind of guidelines regarding indications for MBS. Twenty-two percent are still based on the US National Institute of Health (NIH) 1991 recommendations, 43.5% possess guidelines midway the 1991s and ASMBS/IFSO 2022 ones, and 34% have already adopted the latest ASMBS/IFSO 2022 guidelines. MBS was financially covered in 65% of the countries. Most of the IFSO member societies have MBS guidelines. While more than a third of them have already shifted to the most updated ASMBS/IFSO 2022 ones, another significant number of countries are still following the NIH 1991 guidelines or even do not have any at all. Besides, there is a significant number of countries in which surgical treatment is not yet financially covered. More effort is needed to standardize indications worldwide and to influence insurers and health policymakers to increase the coverage of MBS.

Pujol-Rafols J ，Carmona-Maurici J ，Felsenreich DM ，Shikora SA ，Prager G ，Di Lorenzo N ，De Luca M ，Uyanik O ，Mazzarella M ，D'Arco S ，Angrisani L ，Pardina E ，Balibrea JM ... -  《-》

Scientific evidence for the updated guidelines on indications for metabolic and bariatric surgery (IFSO/ASMBS).

The 2022 American Society for Metabolic and Bariatric Surgery (ASMBS) and International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) updated the indications for metabolic and bariatric surgery (MBS), replacing the previous guidelines established by the National Institutes of Health (NIH) over 30 years ago. The evidence supporting these updated guidelines has been strengthened to assist metabolic and bariatric surgeons, nutritionists, and other members of multidisciplinary teams (MDTs), as well as patients. This study aims to assess the level of evidence and the strength of recommendations compared to the previously published criteria.

De Luca M ，Shikora S ，Eisenberg D ，Angrisani L ，Parmar C ，Alqahtani A ，Aminian A ，Aarts E ，Brown WA ，Cohen RV ，Di Lorenzo N ，Faria SL ，Goodpaster KPS ，Haddad A ，Herrera MF ，Rosenthal R ，Himpens J ，Iossa A ，Kermansaravi M ，Kow L ，Kurian M ，Chiappetta S ，LaMasters T ，Mahawar K ，Merola G ，Nimeri A ，O'Kane M ，Papasavas PK ，Piatto G ，Ponce J ，Prager G ，Pratt JSA ，Rogers AM ，Salminen P ，Steele KE ，Suter M ，Tolone S ，Vitiello A ，Zappa M ，Kothari SN ... -  《-》

Factors Influencing Referral for Bariatric Surgery by Primary Care Physicians in Northern Israel.

Obesity is a chronic metabolic disease with global distribution among adults and children which affects daily functioning and ultimately quality of life. Primary care physicians (PCPs) provide an important role for the treatment of severe obesity. Better understanding of obesity and its treatment options may increase patients' referral rates to the various treatment modalities, including metabolic/bariatric surgery (MBS). A quantitative cross-sectional study used a self-reported questionnaire among PCPs of Clalit Health Services (CHS) in Northern Israel. The quantitative questionnaire examined the PCP's knowledge, opinions, attitude, and approaches to managing severe obesity. A total of 246 PCPs from Northern Israel filled the questionnaire (42.9%), the majority were Muslim Arabs (54.5%), who gained their medical degree outside of Israel (73.8%) and practicing for over 10 years (58.8%). 64.3% of PCPs had a high workload (over 100 appointments per week), 77.1% did not know the definition of severe obesity, and 69.17% did not attend educational meetings regarding obesity during the previous year. The referral rate for MBS was 50.4% ± 23.3. Two prognostic factors that had a statistically significant effect on the referral rate for bariatric surgery were the total appointments per week, and the number of practice years. Both had a negative association. The knowledge and referral rates for bariatric surgery are higher among PCPs with lower workload and relatively fewer practice years. Workshops and annual training courses may fortify knowledge and awareness for the treatment of obesity, which in turn could increase the referral rate for MBS.

Zoabi E ，Elran-Barak R ，Sakran N ，Sandler NK ，Hatoum OA ，Kaplan U ... -  《-》

Primary Care Physicians' Perceptions of Bariatric Surgery and Major Barriers to Referral.

Conaty EA ，Denham W ，Haggerty SP ，Linn JG ，Joehl RJ ，Ujiki MB ... -  《-》