Comment on: International consensus position statement on the role of obesity management medications in the context of metabolic bariatric surgery: expert guideline by the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO)

Sam Tehranchi (email: Ha20813@qmul.ac.uk)

Garrod Building

Turner Street

London

E1 2AD

UK

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BJS, https://doi.org/10.1093/bjs/znae283, published 29 November 2024

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While the role of adjunctive obesity management medications (OMMs) before or after metabolic bariatric surgery is an important area for exploration1, one seemingly neglected aspect is the impact on demand for ‘adjunctive’ procedures, namely body contouring surgery (BCS).

Any potentially synergistic or additive effect of OMMs might modulate both total weight loss and the rate of such loss, which importantly may exacerbate the resulting excess skin. This issue may evade quantification in the literature as a complication, yet is pertinent to patients.

Loose, redundant skin affecting the arms, abdomen and thighs is common after bariatric surgery, frequently causing intertrigo, infection, discomfort, impaired confidence and social withdrawal2. Studies indicate 96% of patients experience issues with redundant skin after bariatric surgery, with 60% reporting impairments in daily physical activity3.

Although BCS is available through NHS funding, it is subject to stringent criteria, liable to further revision if demand soars. Patients may not anticipate the extent of redundant skin, its impact, and the restricted access to adjunctive surgery. Surveys report a strong desire for BCS after bariatric surgery, ranging from 62.4 to 95.4%. However, only 18.5% of patients ultimately undergo these procedures, primarily due to the financial burden4. Positive correlations have been shown between both the degree of weight loss and excess skin, and degree of weight loss and desire for BCS, with patients losing >50kg significantly more likely to seek such procedures compared to those losing <20 kg (5).

The demand for BCS could increase with adjunctive OMMs, with consequent implications to health service costs, patient satisfaction and quality of life. The issue warrants attention in the consent process and we would suggest that extent of skin excess and desire for BCS are considered relevant outcome measures in future studies evaluating the role of adjunctive OMMs.