title: Criteria for patient selection and multidisciplinary evaluation and treatment of the weight loss surgery patient.
abstract: OBJECTIVE
  To provide evidence-based guidelines for patient selection and to recommend the medical and nutritional aspects of multidisciplinary care required to minimize perioperative and postoperative risks in patients with severe obesity who undergo weight loss surgery (WLS).
  
  
  METHODS
  Members of the Multidisciplinary Care Task Group conducted searches of MEDLINE and PubMed for articles related to WLS in general and medical and nutritional care in particular. Pertinent abstracts and literature were reviewed for references. Multiple searches were carried out for various aspects of multidisciplinary care published between 1980 and 2004. A total of 3000 abstracts were identified; 242 were reviewed in detail.
  
  
  RESULTS
  We recommended multidisciplinary screening of WLS patients to ensure appropriate selection; preoperative assessment for cardiovascular, pulmonary, gastrointestinal, endocrine, and other obesity-related diseases associated with increased risk for complications or mortality; preoperative weight loss and cessation of smoking; perioperative prophylaxis for deep vein thrombosis and pulmonary embolism (PE); preoperative and postoperative education and counseling by a registered dietitian; and a well-defined postsurgical diet progression.
  
  
  CONCLUSIONS
  Obesity-related diseases are often undiagnosed before WLS, putting patients at increased risk for complications and/or early mortality. Multidisciplinary assessment and care to minimize short- and long-term risks include: comprehensive medical screening; appropriate pre-, peri-, and postoperative preparation; collaboration with multiple patient care disciplines (e.g., anesthesiology, pulmonary medicine, cardiology, and psychology); and long-term nutrition education/counseling.
authors.affiliation: Jean Mayer U.S. Department of Agriculture Human Nutrition Research Center on Aging at Tufts University, 711 Washington Street, Boston, MA 02111, USA. esaltzman@tufts-nemc.org
authors.forename: Edward
authors.initials: E
authors.lastname: Saltzman
authors.forename: Wendy
authors.initials: W
authors.lastname: Anderson
authors.forename: Caroline M
authors.initials: CM
authors.lastname: Apovian
authors.forename: Hannah
authors.initials: H
authors.lastname: Boulton
authors.forename: Alison
authors.initials: A
authors.lastname: Chamberlain
authors.forename: Diana
authors.initials: D
authors.lastname: Cullum-Dugan
authors.forename: Susan
authors.initials: S
authors.lastname: Cummings
authors.forename: Edward
authors.initials: E
authors.lastname: Hatchigian
authors.forename: Barbara
authors.initials: B
authors.lastname: Hodges
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Keroack
authors.forename: Mark
authors.initials: M
authors.lastname: Pettus
authors.forename: Phyllis
authors.initials: P
authors.lastname: Thomason
authors.forename: Linda
authors.initials: L
authors.lastname: Veglia
authors.forename: Lorraine S
authors.initials: LS
authors.lastname: Young
mesh_terms: D015992:Body Mass Index; D013505:Digestive System Surgical Procedures; D019317:Evidence-Based Medicine; D006801:Humans; D008107:Liver Diseases; D016239:MEDLINE; D009747:Nutritional Physiological Phenomena; D009765:Obesity / Q000601:surgery*; D010353:Patient Education as Topic; D018579:Patient Selection; D011182:Postoperative Care; D011300:Preoperative Care; D012307:Risk Factors; D016540:Smoking Cessation; D020246:Venous Thrombosis; D015431:Weight Loss