title: A numerical scale to assess the outcomes of metabolic/bariatric surgery (NOMS).
abstract: BACKGROUND
  Absent today is a simple numerical system of outcomes assessment that recognizes that bariatric surgery is metabolic surgery and incorporates weight loss, hypertension control, and type 2 diabetes control.
  
  
  OBJECTIVE
  To introduce a simple, new Numerical Scale to Assess the Outcomes of Metabolic Surgery (NOMS).
  
  
  METHODS
  For the stratification of weight outcomes, we used the percentage excess weight loss (%EWL); for hypertension, the systolic blood pressure (SBP) and diastolic blood pressure (DBP) combined with medication usage; and for type 2 diabetes, the hemoglobin A1c (HbA1c) value combined with medication usage.
  
  
  RESULTS
  Utilizing the guidelines of the American Diabetes Association, the Working Group of the European Society of Hypertension, the European Society of Cardiology, and the American College of Cardiology/American Heart Association, we propose for %EWL: W1 ≥ 50, W2 > 25 and < 50, and W3 ≤ 25; for hypertension H1 SBP/DPB < 140/90 mm Hg on no medication, H2 SBP/DBP ≥ 140/90 mm Hg with improvement of SBP or possible reduction of antihypertensive medication, and H3 no change or SBP higher than before surgery; for diabetes mellitus D1 HbA1c ≤ 7% and no medication, D2 HbA1c > 7% with a decrease of the HbA1c level or possible reduction of medication, D3 no change in HbA1c or HbA1c higher than before surgery. Designations of H0 and D0 are given if hypertension or diabetes was not present before surgery. Patient examples for numerical scores are provided.
  
  
  CONCLUSIONS
  The introduction of our numerical scale (NOMS) can be of benefit in metabolic/bariatric outcomes assessment; communications among metabolic/bariatric surgery centers, physicians, and patients; and for more precise reporting in the evidence-based literature.
authors.affiliation: Department of General and Minimally Invasive Surgery, University of Warmia and Mazury, Olsztyn, Poland.
authors.forename: Maciej
authors.initials: M
authors.lastname: Michalik
authors.affiliation: Department of Oncological Surgery, Medical University of Gdansk, Gdansk, Poland.
authors.forename: Maciej
authors.initials: M
authors.lastname: Bobowicz
authors.affiliation: Department of Surgery, University of Minnesota, Minneapolis, Minnesota, USA.
authors.forename: Henry
authors.initials: H
authors.lastname: Buchwald
keywords: bariatric surgery; comorbidities; diabetes; metabolic surgery; numerical system; outcomes assessment