In 1991, The National Institutes of Health (NIH) Consensus Development Conference Panel established general criteria to perform bariatric surgery that includes patients with BMI BMI ?40kg/m2 and patients with less severe obesity (BMI ?35kg/m2) could be considered if they had high-risk comorbid conditions such as life-threatening cardiopulmonary problems (severe sleep apnea, Pickwickian syndrome, or obesity-related cardiomyopathy) or uncontrolled type 2 diabetes mellitus(T2DM)17.
On February 2005, The American College of Surgeons Bariatric Surgery Center Network (ACS BSCN) established an accreditation program for the college staff that develops standards of care, provide reliable income data, develop approvals/verification processes for hospitals facilities and to establish credentialing criteria for surgeons. Some of these instructions focused on criteria for bariatric surgery in adolescents that include: Failed attempts at weight management for six months, BMI ? 35 with serious comorbidities or BMI ? 40 and physiological maturity.11
To successful surgical outcomes, the American Society for Bariatric Surgery (ASBS) was established guidelines in 2006, that clarify the degree of experience, exposure, and support considered to be minimally acceptable credentials for general surgery applicants to be eligible for hospital privileges to perform bariatric surgery such as: The surgeons must have credentials at an accredited facility to perform gastrointestinal and biliary surgery and Have a document that clarifies the surgeons are working within an integrated program for the care of morbidly obese patients that provides ancillary services. 12
The American Society for Metabolic and Bariatric Surgery (ASMBS), American College of Surgeons (ACS), and the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) created guidelines to guide hospitals and institutions credentialing process for bariatric surgery. These include the criteria for the bariatric surgeon and the type of procedure7.
In 2013, The American Society for Metabolic and Bariatric Surgery announced a statement regarding the safety profile and efficacy of bariatric surgery for patients with class I obesity. the statement cleared that the bariatric surgery should be an available option for patients with BMI 30–35 who do not achieve substantial and durable weight and co-morbidity improvement with nonsurgical methods 14.
In 2015, the Ministry of Health in Saudi Arabia formed a committee of experts in the treatment of obesity and produced a guideline in clinical practice. These guidelines recommended the bariatric surgery for the managing obesity in adults (body mass index of ?40 or ?35 kg/m2 with comorbidities)8.
in 2016, The Saudi Arabian Society of Metabolic and Bariatric Surgery (SASMBS) has established guidelines aim to provide recommendations for the prevention and management of overweight/obesity in children and adults that include bariatric surgery It should be performed by an experienced and well trained multidisciplinary team, including surgeons, anesthetists, dietitians, nurses, psychologists and physicians. Adults with a BMI > 30 kg/m2 with poorly controlled type 2 diabetes and high risk of cardiovascular diseases, In post pubertal adolescents with very severe to extreme obesity and severe co-morbidities (SIGN, evidence grade D)15.
in 2016, The American College of Surgeons (ACS) and the American Society for Metabolic and Bariatric Surgery (ASMBS) offered the latest standards for the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP®). Some of this standards; the center must provide access or referral to the following disciplines, as needed, for both preoperative and postoperative care (registered nurses, registered dietitians psychologists, psychiatrists, social workers and physical or exercise therapists) and educate the patients in detail about pathways of performing metabolic and bariatric surgery13.
In 2016, The American Society for Metabolic and Bariatric Surgery (ASMBS) was updated the documents of the 2008 ASMBS Allied Health Nutritional Guidelines for the Surgical Weight Loss Patient guidelines. The focus of this paper is to update the guidelines with findings from the current literature regarding key micronutrient deficiencies and WLS. It can serve as an educational tool not only for dietitians but also for other providers working with pre-WLS patients9.
In 2017, A study was conducted by an email survey of 31 bariatric surgeons, to determine if Saudi Arabia needs more bariatric services. The results of the study showed that Saudi Arabia needs more bariatric surgery services 16.