IFSO Consensus on Definitions and Clinical Practice Guidelines for Obesity Management—an International Delphi Study

Paulina Salminen*, Lilian Kow, Ali Aminian, Lee M. Kaplan, Abdelrahman Nimeri, Gerhard Prager, Estuardo Behrens, Kevin P. White, Scott Shikora, Barham K.Abu Dayyeh, Nasreen Alfaris, Aayeed Al Qahtani, Barbara Andersen, Luigi Angrisani, Ahmad Bashir, Rachel L. Batterham, Estuardo Behrens, Mohit Bhandari, Dale Bond, Jean Marc ChevallierRicardo V. Cohen, Dror Dicker, Claudia K. Fox, Pierre Garneau, Khaled Gawdat, Ashraf Haddad, Jacqués Himpens, Thomas Inge, Marina Kurian, Silvia Leite Faria, Guilherme Macedo, Alexander Dimitri Miras, Violeta Moize, Francois Pattou, Luis Poggi, Jaime Ponce, Almino Ramos, Francesco Rubino, Andrés Sanchez-Pernaute, David Sarwer, Arya M. Sharma, Christine Stier, Christopher Thompson, Josep Vidal, Tarissa Beatrice Zanata Petry

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

13 Scopus citations


Introduction: This survey of international experts in obesity management was conducted to achieve consensus on standardized definitions and to identify areas of consensus and non-consensus in metabolic bariatric surgery (MBS) to assist in an algorithm of clinical practice guidelines for the management of obesity. Methods: A three-round Delphi survey with 136 statements was conducted by 43 experts in obesity management comprising 26 bariatric surgeons, 4 endoscopists, 8 endocrinologists, 2 nutritionists, 2 counsellors, an internist, and a pediatrician spanning six continents over a 2-day meeting in Hamburg, Germany. To reduce bias, voting was unanimous, and the statements were neither favorable nor unfavorable to the issue voted or evenly balanced between favorable and unfavorable. Consensus was defined as ≥ 70% inter-voter agreement. Results: Consensus was reached on all 15 essential definitional and reporting statements, including initial suboptimal clinical response, baseline weight, recurrent weight gain, conversion, and revision surgery. Consensus was reached on 95/121 statements on the type of surgical procedures favoring Roux-en-Y gastric bypass, sleeve gastrectomy, and endoscopic sleeve gastroplasty. Moderate consensus was reached for sleeve gastrectomy single-anastomosis duodenoileostomy and none on the role of intra-gastric balloons. Consensus was reached for MBS in patients > 65 and < 18 years old, with a BMI > 50 kg/m2, and with various obesity-related complications such as type 2 diabetes, liver, and kidney disease. Conclusions: In this survey of 43 multi-disciplinary experts, consensus was reached on standardized definitions and reporting standards applicable to the whole medical community. An algorithm for treating patients with obesity was explored utilizing a thoughtful multimodal approach. Graphical Abstract: [Figure not available: see fulltext.].

Original languageEnglish (US)
Pages (from-to)30-42
Number of pages13
JournalObesity Surgery
Issue number1
StatePublished - Jan 2024


  • Anti-obesity medications
  • Bariatric endoscopy
  • Bariatric surgery
  • Consensus
  • Definitions
  • Delphi survey
  • IFSO
  • Medical treatment
  • Metabolic bariatric surgery
  • Obesity, Severe obesity
  • Outcomes

ASJC Scopus subject areas

  • Nutrition and Dietetics
  • Surgery
  • Endocrinology, Diabetes and Metabolism


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