Skip to main content

Advertisement

SpringerLink
Log in

Report: Asian Consensus Meeting on Metabolic Surgery. Recommendations for the use of Bariatric and Gastrointestinal Metabolic Surgery for Treatment of Obesity and Type II Diabetes Mellitus in the Asian Population

August 9th and 10th, 2008, Trivandrum, India

  • Guidelines
  • Published:
Obesity Surgery Aims and scope Submit manuscript

Abstract

Background

The report submitted is a detailed analysis of the happenings and outcomes of a two day deliberation that was organized in Trivandrum, India on the 9th and 10th August 2009.

Methods

Asian Consensus Meeting on Metabolic Surgery (ACMOMS) was the first ever meeting of its kind in Asia where 52 professionals involved in the field of bariatric surgery, metabolic surgery, diabetes, and medical research from countries across Asia and the GCC met at Trivandrum, India to vote for and create a new set of guidelines for the Asian genotype, which were different from the NIH guidelines set for bariatric surgery. The aim was to set culturally, geographically, and genetically relevant standards for the management of obesity and metabolic syndrome.

Results

It is known that Asians have a higher adiposity for a given level of obesity, and this is visceral obesity as compared to other populations. Currently, all over the world and in Asia as well, guidelines set by NIH in 1991 are being followed. Surgeons believe that NIH guidelines need to be revisited and modified. It is in light of these observations that the genesis of ACMOMS took place. At ACMOMS, it was recommended that the NIH guidelines are not suitable for Asians, and the BMI guidelines should be lowered for indication of surgery. Waist or waist–hip ratio must gain significance as compared to BMI alone in Asia.

Conclusions

The collective recommendations were submitted as a report to the executive committee for approval. As the Asia Pacific region consists of more than half of the world's population, the dire health and economic consequences of this epidemic demand urgent action from the medical fraternity in this region, and we hope that the recommendations will help to review the currently accepted guidelines.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Hossain P, Kawar B, El Nahas M. Obesity and diabetes in the developing world—a growing challenge. N Engl J Med. 2007;356:3.

    Article  Google Scholar 

  2. Ko GTC, Tang JSF. Waist circumference and BMI cut-off based on 10-year cardiovascular risk: evidence for central pre-obesity. Obesity. 2007;15(11):2832–40.

    Article  PubMed  Google Scholar 

  3. World Health Organisation. Physical status: the use and interpretation of anthropometry. Technical Report Series 854, Geneva; 1995.

  4. Amos A, McCarty D, Zimmet P. The rising global burden of diabetes and its complications: estimates and projections to the year 2010. Diabetic Med. 1997;14 Suppl 5:S1–S85.

    PubMed  Google Scholar 

  5. Deurenberg-Yap M, Schmidt G, van Staveren WA, et al. The paradox of low body mass index and high body fat percentage among Chinese, Malays and Indians in Singapore. Int J Obese Relat Metab Disord. 2000;24(8):1011–7.

    Article  CAS  Google Scholar 

  6. Wang J, Thornton JC, Russell M, et al. Asians have lower body mass index (BMI) but higher percent body fat than do whites: comparisons of anthropometric measurements. Am J Clin Nutr. 1994;60:23–8.

    CAS  PubMed  Google Scholar 

  7. Chang C-J, Wu C-H, Chang C-S, et al. Low body mass index but high percent body fat in Taiwanese subjects: implications of obesity cutoffs. Int J Obes. 2003;27:253–9.

    Article  Google Scholar 

  8. Vague J. Sexual differentiation, a factor affecting the forms of obesity. Presse Med. 1947;30:339–40.

    Google Scholar 

  9. Wild S, Roglic G, Green A, et al. Global prevalence of diabetes, estimates for the year 2000 and projections for 2030. Diabetes Care. 2004;27:1047–53.

    Article  PubMed  Google Scholar 

  10. Reddy KS, Yusuf S. Emerging epidemic of cardiovascular disease in developing countries. Circulation. 1998;97:596–601.

    CAS  PubMed  Google Scholar 

  11. McKeigue PM, Shah B, Marmot MG. Relation of central obesity and insulin resistance with high diabetes prevalence and cardiovascular risk in South Asians. Lancet. 1991;337(8747):971–3.

    Article  Google Scholar 

  12. Joshi R. Metabolic syndrome—emerging clusters of the Indian phenotype. J Assoc Physicians India. 2003;51:445–6.

    PubMed  Google Scholar 

  13. Yusuf S, Hawken S, Ounpuu S, et al. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries [the INTERHEART study]: case-control study. Lancet. 2004;364(9438):937–52.

    Article  PubMed  Google Scholar 

  14. Shelgikar KM, Hockaday TD, Yajnik CS. Central rather than generalized obesity is related to hyperglycaemia in Asian Indian subjects. Diabet Med. 1991;8:712–7.

    Article  CAS  PubMed  Google Scholar 

  15. Yajnik CS. Obesity epidemic in India: intrauterine origins? Proc Nutr Soc. 2004;63:387–96.

    Article  CAS  PubMed  Google Scholar 

  16. Bavdekar A, Yajnik CS, Fall CHD, et al. The insulin resistance syndrome [IRS] in eight-year old Indian children: small at birth, big at 8 years or both? Diabetes. 2000;48:2422–9.

    Article  Google Scholar 

  17. Neel JV. Diabetes mellitus: a ‘thrifty’ genotype rendered detrimental by ‘progress’? Am J Hum Genet. 1962;14:353–62.

    CAS  PubMed  Google Scholar 

  18. WHO Expert Consultation. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet. 2004;363(9403):157–63.

    Article  Google Scholar 

  19. Gupta R, Rastogi P, Sarna M, et al. Body-mass index, waist-size, waist–hip ratio and cardiovascular risk factors in urban subjects. J Assoc Physicians India. 2007;55:621–7. www.japi.org.

    CAS  PubMed  Google Scholar 

  20. National Cholesterol Education Program. Third report of the National Cholesterol Education Program Expert Panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel-III). Circulation. 2002;106:3143–421.

    Google Scholar 

  21. Goldstein DJ. Beneficial health effects of modest weight loss. Int J Obes. 1992;16:397–415.

    CAS  Google Scholar 

  22. National Institutes of Health. Gastrointestinal surgery for severe obesity: national institutes of health consensus conference statement. Am J Clin Nutr. 1992;55:6159.

    Google Scholar 

  23. Brandle M, Zhou H, Smith BRK, et al. The direct medical cost of type 2 diabetes. Diabetes Care. 2003;26:2300–4.

    Article  PubMed  Google Scholar 

  24. Cohen R, Pinheiro J, Correa J, et al. Laparoscopic Roux en-y gastric bypass for BMI less than 35 kg/m2: a tailored approach. Surg Obes Relat Dis. 2006;2(3):401–4

    Google Scholar 

  25. Mingrone G, De Gaetano A, Greco AV, et al. Reversibility of insulin resistance in obese diabetic patients: role of plasma lipids. Diabetologia. 1997;40:599–605.

    Article  CAS  PubMed  Google Scholar 

  26. Noya G, Cossu ML, Coppola M, et al. Biliopancreatic diversion preserving the stomach and pylorus in the treatment of hypercholesterolemia and diabetes type II: results in the first 10 cases. Obes Surg. 1998;8:67–72.

    Article  CAS  PubMed  Google Scholar 

  27. O’brien P, Dixon JB, Laurie C, et al. Treatment of mild to moderate obesity with laparoscopic adjustable Gastric banding or an intensive medical program a randomized trial. Ann Intern Med. 2006;144:625–33.

    PubMed  Google Scholar 

  28. Han SM, Kim WW, Hyun Oh J. Results of laparoscopic sleeve gastrectomy (LSG) at 1 year in morbidly obese Korean patients. Obes Surg. Online publication.

  29. Lee WJ, Wang W, Lee YC, et al. Effect of laparoscopic mini-gastric bypass for T2DMMellitus: comparison of BMI >35 and <35 kg/m2. J Gastrointest Surg. 2008;12:945–52.

    Article  PubMed  Google Scholar 

  30. American Diabetes Association. Standards of medical care in diabetes—2008. Diabetes Care. 2008;31(1):S12–54.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Center for Obesity and Diabetes Support, Mumbai, India

    Muffazal Lakdawala & Aparna Bhasker

  2. Department of Minimally Invasive Surgery, Saifee Hospital, Mumbai, India

    Muffazal Lakdawala

  3. Lilavati Hospital, Mumbai, India

    Muffazal Lakdawala

  4. Saifee Hospital, Mumbai, India

    Aparna Bhasker

Authors
  1. Muffazal Lakdawala
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Aparna Bhasker
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Muffazal Lakdawala.

Appendix

Appendix

Executive Committee Members

Chair: Dr. Bansi Saboo, Endocrinologist, Hon Secretary RSSDI, Gujarat, India; Dr. Harry Frydenberg, Bariatric Surgeon, Epsworth Training Center, President: International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO), Melbourne, Australia; Dr. John Dixon, Head of Clinical Research, Centre for Obesity Research and Education and Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia; Dr. M. A. Lakdawala, Bariatric Surgeon, Chief: Department of Minimal Access Surgery, Saifee Hospital, Mumbai, Founder, Centre of Obesity & Diabetes Support, Vice President: Obesity and Metabolic Surgery Society of India [OSSI], Mumbai, India; Dr. Pradeep Chowbey, Bariatric Surgeon, President Elect: IFSO APC, Governor, Society of Endoscopic and Laparoscopic Surgeons of Asia (ELSA), Chairman, Minimal access, Metabolic and Bariatric Surgery Centre, Sir Gangaram Hospital, New Delhi, India; Dr. Rolf Hartung, Consultant Surgeon, Head of General Surgery, Dubai Hospital, Government of Dubai and Associate Professor of Surgery, Dubai Medical College, Dubai; Dr. S. Bandukwala, Physician, Saifee Hospital, Lilavati Hospital, Mumbai, India; Dr. S. Joshi, Endocrinologist; Lilavati Hospital, Vice President RSSDI, President Elect AAIRO, Mumbai, India; Dr. W.J. Lee, Bariatric Surgeon, President: Asia Pacific Bariatric Surgery Society (APBSS), Director, Asia Pacific Endoscopy Bariatric Surgical Center, Professor of Surgery, National Taiwan University, Chairman, Asia Pacific Bariatric Surgical Group, President, Taiwan Association for Endoscopic Surgery, Taiwan.

Speakers at the Summit

Organizer and Convenor: Dr. M. A. Lakdawala, Bariatric Surgeon, Chief: Department of Minimal Access Surgery, Saifee Hospital, Mumbai, Founder, Centre of Obesity & Diabetes Support, Vice President: Obesity and Metabolic Surgery Society of India [OSSI], Mumbai, India.

Co-Convenor: Dr. Pradeep Chowbey, Bariatric Surgeon, President Elect: IFSO APC, Governor, Society of Endoscopic and Laparoscopic Surgeons of Asia [ELSA], Chairman, Minimal access, Metabolic and Bariatric Surgery Centre, Sir Gangaram Hospital, New Delhi, India

Keynote speakers: All the members of the executive committee were speakers at the summit. Dr. Ashok Damodaran, MS, DNB, Pakar Perunding Bedah, Hospital Sebu, Malaysia; Dr. Anton Cheng, FRCS (Ed), FRACS, Senior Consultant, Department of surgery, Alexandra Hospital, Singapore; Dr. Hildegardes C. Dineros, Bariatric and metabolic surgeon, Healing hand clinic and St. Luke’s Medical center, Philippines; Dr. Prashant Mathur, DCH, DNB, PhD, MNAMS, Assistant Director General, Division of non communicable diseases, Indian council of medical research, New Delhi, India; Dr. Faruq Badiuddin, MS, FRCS, Consultant Surgeon, Wellness medical center, Rosary medical center, Village medicenter, Dubai; Dr. Wilfred Lik Man Mui,MBChB, FRCS (Ed), FRACS, Union Hospital, Hongkong; Dr. Chih-Kun Huang, Chief- International Endoscopic Obesity Center, E-Da Hospital and I- Shou University, Taiwan; Dr. Sang Moon Han, MD, Assistant Professor, Department of surgery, College of medicine, Pochon, CHA University-CHA General Hospital, Korea; Prof. Paisal Pongchairerks, MD, FICS, FRCS,Thai board of general Surgery, Thailand; Dr. Mahendra Narwaria, MS, Asian institute of gastroenterology surgery, President- Obesity and metabolic surgery society of India; Dr. Ramen Goel, MS, Wockhardt hospital and Bombay hospital, India; Dr. Surendra Ugale, MS, Kirloskar hospital, Hyderabad, India; Dr. S. Sheikh, MD, Consultant endocrinologist, Saifee hospital, Mumbai, India; Dr. S. Goel, MD, Consultant anesthetist, Saifee Hospital, Center for Obesity and Diabetes Support, Mumbai, India.

Summit Organizing Committee

Dr. Yasin Kazi, MS, Consultant surgeon, Center for Obesity and Diabetes Support, Mumbai, India; Dr. Aparna Govil Bhasker, Consultant surgeon, Center for Obesity and Diabetes Support, Mumbai, India; Payal Batra, Consultant nutritionist, Center for Obesity and Diabetes Support, Mumbai, India; Sneha Jain, Consultant nutritionist, Center for Obesity and Diabetes Support, Mumbai, India.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Lakdawala, M., Bhasker, A. Report: Asian Consensus Meeting on Metabolic Surgery. Recommendations for the use of Bariatric and Gastrointestinal Metabolic Surgery for Treatment of Obesity and Type II Diabetes Mellitus in the Asian Population. OBES SURG 20, 929–936 (2010). https://doi.org/10.1007/s11695-010-0162-7

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11695-010-0162-7

Keywords

Search

Navigation