IFSO/ASMBS Guidelines Expand Criteria for Bariatric Surgery: Will the Coverage by Third-Party Payors Follow?
IFSO/ASMBS Guidelines Expand Criteria for Bariatric Surgery: Will the Coverage by Third-Party Payors Follow?
复制标题
IFSO/ASMBS 指南扩大了减肥手术的标准：第三方付款人的承保范围会遵循吗？
DOI：
10.1007/s11695-022-06394-1
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发表时间：
2023
期刊：
影响因子：
2.9
通讯作者：
Sarwer,DavidB
中科院分区：
文献类型：
--
作者：
Gasoyan,Hamlet;Sarwer,DavidB
预计到2030年，全球将有超过10亿人患有肥胖症（体重指数[BMI]≥ 30 kg/m2），其中包括五分之一的女性和七分之一的男性[1]。在美国，到2030年，每两个成年人中就有一个患有肥胖症，每四个成年人中就有一个患有临床重度肥胖症（≥ 40 kg/m2）[2]。虽然欧洲和北美的肥胖患病率稳步上升，但世界其他地区，包括低收入和中等收入国家，肥胖率正在迅速上升[1]。这一增加是必然的。据估计，2019年肥胖和超重的直接和间接成本占全球国内生产总值的2.19%，世界卫生组织美洲地区的这一数字高达2.99%[3]。这种疾病的负担不仅仅是经济上的。与BMI正常的人相比，I级肥胖（≥ 30至< 35 kg/m2）的个体估计会损失3-4年的无病寿命[4]。对于II级或III级肥胖（≥ 35 kg/m2）的个体，这是7-8年无疾病的损失，没有重大的非传染性疾病，如2型糖尿病，冠心病，中风和癌症[4]。幸运的是，全球医学界可以为肥胖症患者提供安全有效的治疗方案。许多研究证明了减肥手术的安全性和长期有效性[5-7]。同样，在抗肥胖药物的开发方面也取得了重大进展，新药物的疗效比以前认为安全有效的药物更好[8]。尽管减肥手术的安全性和减肥效果的持久性，但该手术仍然严重未得到充分利用。全世界每年约有686，000人接受手术[9]，约占符合BMI标准的1%[10]。造成这种情况的原因是多方面的，包括患者和医生对手术疗效和安全性的态度，跨学科的转诊做法，医疗保健系统内外的体重偏见，以及对于拥有私人医疗保险模式的国家，保险福利设计特点[10]。2022年美国代谢和减肥手术学会（ASMBS）和国际肥胖和代谢疾病外科联合会（IFSO）发表了一份关于减肥手术及其适应症的现有科学信息的联合声明[5]。这次审查以及由此产生的手术适应症的变化，代表了1991年出版的美国国立卫生研究院指南的第一次重大更新之一。该声明强调了大量的科学证据，支持减肥手术的有效性和安全性，这些证据是在过去三十年中从研究人员和临床医生，外科医生和专职卫生专业人员那里出现的。指南中最显著的变化之一是BMI≥ 35 kg/m2的个体使用手术的适应症，无论是否存在体重相关合并症或其严重程度如何。对于患有代谢性疾病和I类肥胖的成年人以及适当选择的18岁以下的个体，也应该考虑减肥手术。亚洲个体的BMI标准降至BMI≥ 27.5 kg/m2 [5]。联合声明是朝着将减肥手术扩大到数十万人的方向迈出的重要一步。然而，该指南还有待世界各地的政府医疗机构和私人医疗保险公司采用。这些第三方支付者的减肥手术覆盖范围需要相应的变化，因为他们广泛...
More than one billion people globally, including one in five women and one in seven men, are projected to be living with obesity (body mass index [BMI]≥ 30 kg/m2) by 2030 [1]. In the USA, one in two adults will have obesity and one in four will have clinically severe obesity (≥ 40 kg/m2) by 2030 [2]. While the prevalence of obesity in Europe and North America is increasing steadily, other parts of the world, including low-and middle-income countries, are experiencing a rapid rise in obesity [1]. This increase is consequential. The direct and indirect costs of obesity and overweight were estimated to be 2.19% of the global gross domestic product in 2019, with the figure being as high as 2.99% in the Americas region of the World Health Organization [3]. The burden of the disease is not just financial. Individuals with class I obesity (≥ 30 to< 35 kg/m2), as compared to those with a normal BMI, are estimated to lose 3–4 diseasefree years of their lives [4]. For individuals with class II or III obesity (≥ 35 kg/m2), it is a loss of 7–8 disease-free years without major, non-communicable diseases, such as type 2 diabetes, coronary heart disease, stroke, and cancer [4]. Fortunately, safe and effective treatment options for individuals with obesity are available to the global medical community. Numerous studies demonstrated the safety and longterm effectiveness of bariatric surgery [5–7]. Similarly, there has significant progress in the development of anti-obesity medications, with novel agents having greater efficacy than those previously judged safe and effective [8]. Despite the safety of bariatric surgery and the durability of weight loss outcomes, the procedures remain profoundly underused. Approximately 686,000 individuals around the world undergo surgery annually [9], representing about 1% of individuals who meet the BMI criteria [10]. The reasons for this are multifactorial, including attitudes about the efficacy and safety of surgery held by patients and physicians, referral practices across medical disciplines, weight bias both in and outside of health care systems, and, for countries that have private health insurance models, insurance benefit design features [10].The 2022 American Society for Metabolic and Bariatric Surgery (ASMBS) and the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) published a joint statement on the currently available scientific information on bariatric surgery and its indications [5]. This review, and resulting changes to the indications for surgery, represents one of the first major updates to the National Institutes of Health guidelines published in 1991. The statement highlights the large body of scientific evidence supporting the efficacy and safety of bariatric surgery that has emerged from investigators and clinicians, surgeons, and allied health professionals, over the past three decades. One of the most significant changes in the guidelines is the indication for the use of surgery with individuals with a BMI≥ 35 kg/m2, regardless of the presence, absence, or severity of weight-related co-morbidities. Bariatric surgery also should be considered for adults with metabolic disease and class I obesity as well as appropriately selected individuals under the age of 18. The BMI criteria for Asian individuals were reduced to BMI≥ 27.5 kg/m2 [5]. The joint statement is an important step forward toward expanding access to bariatric surgery to hundreds of thousands of individuals. However, the guidelines await adoption from government-run health care agencies, as well as private health insurers, around the world. Corresponding changes in coverage for bariatric surgery by these third-party payors are needed for their widespread …