OSSI GUIDELINES FOR BARIATRIC AND METABOLIC SURGERY:

As a national body of bariatric and metabolic surgeons in India, OSSI through its Executive Committee published guidelines on Obesity and Metabolic Surgery and keep updating it on a regular basis. Since the publishing of its first guidelines in 2017, there has been 2 more additions, latest being released in 2023. These guidelines postulate:

• Obesity is a disease and not just a life style disorder.
• Bariatric and metabolic surgeries are gastrointestinal surgeries to improve, prevent and/or treat obesity and its co morbidities which may be life threatening.
• This is a life altering or life saving surgery and not cosmetic surgery.
• Asians, and in particular the Indian population needs a more aggressive approach in treating obesity and its co-morbidities as it is associated with higher morbidity and mortality at a relatively lower BMI.
• Presently accepted bariatric and metabolic surgeries are based on principles of restriction, malabsorption and satiation.
• Surgery for treatment of type 2 diabetes and metabolic syndrome in patients with or without obesity is considered as metabolic surgery since these gastrointestinal surgical procedures have anti-diabetic & metabolic effects independent of weight loss.

INDICATIONS FOR SURGERY:

• BMI above 32.5 kg/m2 with obesity related co-morbidities
• BMI above 37.5 kg/m2 without co-morbidities.
• BMI > 30 kg/m2 with life threatening obesity related disorders like uncontrolled diabetes, cardiovascular disease / cardiomyopathy and severe obstructive sleep apnoea.
• Patients motivated to lose weight and commitment to long term follow up
• Patient should have attempted conservative methods of weight loss and failed in the past
• Bariatric Surgery to be considered only between ages of 18 - 65 years
  • Bariatric surgery may be considered in patients more than 65 years in the presence of severe obesity related co-morbidities / disability
  • Bariatric Surgery may be considered in patients < 18 years in special situations after pediatrician / endocrinology certification , or after attainment of puberty or completion of skeletal maturity

CONTRA-INDICATIONS FOR SURGERY:

The absolute contra-indications for bariatric surgery include:

• Drug and/or Alcohol abuse
• Uncontrolled Psychological Disease
• Pregnancy

STANDARD PROCEDURES:

The presently accepted bariatric procedures include:

• Adjustable Gastric Band (AGB)
• Vertical Sleeve Gastrectomy(VSG)
• Roux en Y Gastric Bypass(RYGB)
• One Anastomosis Gastric Bypass (OAGB)
• Biliopancreatic Diversion with Duodenal Switch (BPD-DS).
• Procedure series that are published by an Indian author in peer reviewed journal are eligible as non-standard, but under OSSI guidelines.
• All other un-published procedures would be defined experimental / novel procedures. Any novel procedure or surgery on patients outside the guidelines can only be done in the context of a clinical trial after an ICMR approved ethics committee clearance and registration in either www.clinicaltrials.gov or www.ctri.nic.in or by surgeons who have completed appropriate clinical trails.

PREGNANCY AFTER SURGERY:

Pregnancy has to be planned:

• At least 12 to 18 months after surgery or until stabilization of weight occurs
• Artificial reproductive therapy(ART) can be initiated 12 months after surgery

INTERNATIONAL GUIDELINES:

All International bariatric and metabolic surgery association including International Federation for Obesity and Metabolic Surgery (IFSO), American Society for Metabolic and Bariatric Surgery (ASMBS), British Obesity and Metabolic Surgery Society (BOMSS) have published similar guidelines which are accessible through their official website.