OSSI GUIDELINES FOR BARIATRIC AND METABOLIC SURGERY:

As a national body of bariatric surgeons in India, OSSI through its Executive Committee published its 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 include:

• 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 lifesaving 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 restrictive, malabsorptive and combined procedures.
• 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.
• All surgeons who are 'full members' of OSSI are members of IFSO (International Federation for the Surgery of Obesity and Metabolic Disorders) and are eligible to perform bariatric & metabolic surgery.

INDICATIONS FOR BARIATRIC 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 diabetes, cardiovascular disease and severe obstructive sleep apnoea.

STANDARD BARIATRIC PROCEDURES:

The presently accepted bariatric procedures include restrictive, malabsorptive and combination surgeries of both.

• The procedures considered standard include Adjustable Gastric Band (AGB), Vertical Sleeve Gastrectomy(VSG), Roux en Y Gastric Bypass(RYGB), One Anastomosis Gastric Bypass (OAGB) and Biliopancreatic Diversion with Duodenal Switch (BPD-DS).
• Procedure series that are published by an Indian author in per review journal are eligible as non-standard, but eligible under OSSI guidelines.
• All other procedures would be defined experimental / novel bariatric 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.

INDICATIONS FOR BARIATRIC SURGERY:

• BMI >37.5 without presence of any obesity related co-morbidities or
• BMI > 32.5 with the presence of type 2 Diabetes / any obesity related co-morbidities
• Patients motivated to lose weight and commitment to long term follow up
• Patient should have attempted conservative methods of weight loss and failed
• 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 , but after attainment of puberty or completion of skeletal maturity

CONTRA-INDICATIONS:

The absolute contra-indications for bariatric surgery include Drug and/or Alcohol abuse, Uncontrolled Psychological Disease and Pregnancy

PREGNANCY AFTER BARIATRIC SURGERY:

Pregnancy has to be planned at least 15-18 months after the bariatric surgery. Artificial reproductive therapy (ART) can be initiated 12 months after the bariatric surgery.