This protocol addresses patients with obesity who have received pharmacotherapy combined with lifestyle changes but have not achieved sufficient early weight loss—typically defined as greater than 5% weight reduction after 3 months of treatment.
The prior line—obesity pharmacotherapy with lifestyle changes—targets sufficient early weight loss (typically >5% at 3 months). When that threshold is not reached, escalation to the next structured approach is indicated.
For patients meeting specific BMI criteria who are otherwise good surgical candidates, a metabolic surgical approach is considered for both weight and glycemic management, performed at specialised high-volume centres.
DOI: 10.2337/dc26-S008
Consider metabolic surgery as a weight and glycemic management approach in people with type 2 diabetes with BMI ≥30.0 kg/m² (or ≥27.5 kg/m² in Asian American individuals) who are otherwise good surgical candidates.
Metabolic surgery should be performed in high-volume centers with interprofessional teams knowledgeable about and experienced in managing obesity, diabetes, and gastrointestinal surgery.
The overwhelming majority of procedures performed in the U.S. are vertical sleeve gastrectomy (VSG) and Roux-en-Y gastric bypass (RYGB).
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