Episode Details

This is the Weight and Healthcare newsletter! If you appreciate the content here, please consider supporting the newsletter by subscribing and/or sharing!

In October, “Guidelines on Indications for Metabolic and Bariatric Surgery” were put out. While I don’t think that these surgeries meet the requirement for ethical, evidence-based medicine, in looking at these guidelines specifically, here are some things that I think it’s important to know.

The guidelines were put out by The American Society for Metabolic and Bariatric Surgery (ASMBS) which is “the largest group of bariatric surgeons and integrated health professionals in the United States” and the International Federation for the Surgery of Ob*sity and Metabolic Disorders (IFSO) which “represents 72 national associations and societies throughout the world.” These are both organizations that primarily represent those who profit from these surgeries.

They were published in two journals. Surgery for Ob*sity and Related Diseases (SOARD) a medical journal “medical journal covering the use of surgery to treat obesity and related medical conditions” and Ob*sity Surgery which is a journal dedicated to bariatric surgery which is “the official journal of the International Federation for the Surgery of Obesity and Metabolic Disorders.” Note that it is the official journal of the organization that created the guidelines, that represents people who profit from the surgeries. I also think that this is an example of the ways in which (what passes for) science around “ob*sity *medicine” can end up putting profits first.

In this case, two organizations that represent those who profit from weight loss surgery have published in two journals dedicated to supporting these surgeries, in order to create new guidelines which would vastly increase their market share because those who belong to these organizations can use the guidelines to justify performing these surgeries on many more patients.

Fox, meet henhouse.

The guidelines gain ground on two of the industry’s constant focuses – lowering the BMI threshold for these procedures, and lowering the age of the patients they are allowed to perform these procedures on.

To do this, they rely on several tried-and-true questionable ideas:

Pathologizing higher-weight bodies

This is the result of a long game that they (and the entire weight loss industry) have been playing to pathologize bodies based on size (and regardless of actual metabolic health.) Making up the concept of “ob*sity” (based on a height/weight ratio) and then transitioning that to a standalone “disease” allows them to make every fat person their market.

In this case, the old guidelines were a adults with “BMI of at least 40 or a BMI of 35 or more and at least one obesity-related condition” the new guidelines are adults and “appropriately selected children and adolescents” with a BMI of 35 or more “regardless of presence, absence, or severity of obesity-related conditions,” a “BMI of 30-34.9 and metabolic disease” and in “Asian individuals beginning at BMI 27.5.”

If you’re playing the home game, these new guidelines increase the market for these surgeries by creating a 5-point BMI drop for the weight at which, no matter what the patient’s metabolic health, they want to give them a surgery that risks their life and quality of life, a 5 point BMI decrease for patients for whom they are recommending these dangerous surgeries based on the fact that they are fat and have a health issue that thin people also get, and a special category for Asian people

There is a lot to unpack here. First of all, the idea that people at a higher BMI