Current recommendations for procedure selection in class I and II obesity developed by an expert modified Delphi consensus
Authors: Kermansaravi Mohammad , Chiappetta Sonja , Parmar Chetan , Shikora Scott A. , Prager Gerhard , LaMasters Teresa , Ponce Jaime , Kow Lilian , Nimeri Abdelrahman , Kothari Shanu N. , Aarts Edo , Abbas Syed Imran , Aly Ahmad , Aminian Ali , Bashir Ahmad , Behrens Estuardo , Billy Helmuth , Carbajo Miguel A. , Clapp Benjamin , Chevallier Jean-Marc , Cohen Ricardo V. , Dargent Jerome , Dillemans Bruno , Faria Silvia L. , Neto Manoel Galvao , Garneau Pierre Y. , Gawdat Khaled , Haddad Ashraf , ElFawal Mohamad Hayssam , Higa Kelvin , Himpens Jaques , Husain Farah , Hutter Matthew M. , Kasama Kazunori , Kassir Radwan , Khan Amir , Khoursheed Mousa , Kroh Matthew , Kurian Marina S. , Lee Wei-Jei , Loi Ken , Mahawar Kamal , McBride Corrigan L. , Almomani Hazem , Melissas John , Miller Karl , Misra Monali , Musella Mario , Northup C. Joe , O’Kane Mary , Papasavas Pavlos K. , Palermo Mariano , Peterson Richard M. , Peterli Ralph , Poggi Luis , Pratt Janey S. A. , Alqahtani Aayad , Ramos Almino C. , Rheinwalt Karl , Ribeiro Rui , Rogers Ann M. , Safadi Bassem , Salminen Paulina , Santoro Sergio , Sann Nathaniel , Scott John D. , Shabbir Asim , Sogg Stephanie , Stenberg Erik , Suter Michel , Torres Antonio , Ugale Surendra , Vilallonga Ramon , Wang Cunchuan , Weiner Rudolf , Zundel Natan , Angrisani Luigi , De Luca Maurizio 
Published: February 2024

Metabolic and bariatric surgery (MBS) is widely considered the most effective option for treating obesity, a chronic, relapsing, and progressive disease. Recently, the American Society of Metabolic and Bariatric Surgery (ASMBS) and the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) issued new guidelines on the indications for MBS, which have superseded the previous 1991 National Institutes of Health guidelines. The aim of this study is to establish the first set of consensus guidelines for selecting procedures in Class I and II obesity, using an Expert Modified Delphi Method. In this study, 78 experienced bariatric surgeons from 32 countries participated in a two-round Modified Delphi consensus voting process. The threshold for consensus was set at an agreement or disagreement of ≥ 70.0% among the experts. The experts reached a consensus on 54 statements. The committee of experts reached a consensus that MBS is a cost-effective treatment option for Class II obesity and for patients with Class I obesity who have not achieved significant weight loss through non-surgical methods. MBS was also considered suitable for patients with Type 2 diabetes mellitus (T2DM) and a body mass index (BMI) of 30 kg/m2 or higher. The committee identified intra-gastric balloon (IGB) as a treatment option for patients with class I obesity and endoscopic sleeve gastroplasty (ESG) as an option for patients with class I and II obesity, as well as for patients with T2DM and a BMI of ≥ 30 kg/m2. Sleeve gastrectomy (1) and Roux-en-Y gastric bypass (RYGB) were also recognized as viable treatment options for these patient groups. The committee also agreed that one anastomosis gastric bypass (OAGB) is a suitable option for patients with Class II obesity and T2DM, regardless of the presence or severity of obesity-related medical problems. The recommendations for selecting procedures in Class I and II obesity, developed through an Expert Modified Delphi Consensus, suggest that the use of standard primary bariatric endoscopic (IGB, ESG) and surgical procedures (SG, RYGB, OAGB) are acceptable in these patient groups, as consensus was reached regarding these procedures. However, randomized controlled trials are still needed in Class I and II Obesity to identify the best treatment approach for these patients in the future.