NIH Consensus Conference
In March of 1991 the National Institutes of Health brought together over 50 experts for a three day Consensus Conference . These individuals represented the fields of Surgery, Gastroenterology, Endocrinology, Psychiatry, Nutrition, as well as the public. This panel was charged with the task of reviewing the current knowledge pertaining to obesity, its consequences and treatment options. Following two days of expert presentation, discussion and deliberation the panel weighed the evidence and prepared their Consensus Statement.
The NIH Consensus Statement demonstrated a critical shift in attitudes toward weight loss surgery. Specifically, an evaluation of the medical literature demonstrated that weight loss surgery was safe, effective, and represented the only viable option for long term treatment of severe obesity. Further it provided the foundation for the concept comprehensive bariatric care including not only surgery, but nutrition/exercise education and psychosocial support.
Read the full text in the Consensus Statement tab. Several important conclusions include:
The risk associated with obesity is proportional to the degree of overweight, and can be measured by the Body Mass Index (BMI). Persons at the highest risk , with a BMI > 40, are classified as “clinically severe obesity.”
Medical therapy, as defined by diet, exercise, behavior modification, and medications, may show moderate and short term success, but most regain their lost weight within a year. There is no evidence that any form of medical therapy can achieve sustained weight , and in fact “may heighten ones sense of personal failure and decrease motivation for further therapy.”
Surgical Procedures for obesity, conversely, produce sustained weight loss, improve comorbidities, and demonstrate relatively low mortality.
Patient Selection for Surgical Weight loss includes those whose BMI exceeds 40 or those with a BMI of 35 – 40 along with high risk comorbid conditions, such as heart and lung disease, diabetes mellitus, or life-limiting joint disease.
For those undergoing weight loss surgery the panel recommended:
- Treatment first in a nonsurgical program including integrated components of a dietary regimen, appropriate exercise, behavior modification and support.
- Patients should be well informed and motivated with acceptable operative risks
- Patients should be selected carefully after evaluation by a multidisciplinary team with medical, surgical, psychiatric, and nutritional expertise.
- The surgeon be substantially experienced and working in a clinical setting with adequate support for all aspects of management.
- Lifelong medical surveillance after surgical therapy is a necessity.
Since these conclusions were made, multiple medical societies have additionally demonstrated their support for weight loss surgery. See documentation below.
Societies Supporting Bariatric Surgery