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Massive Weight Loss Surgery

Indications and contraindications

Authors: Anne Mosebo, Med. Stud., Mie Pilegaard Bjarnesen, Med. Stud. and Magnus Balslev Avnstorp, MD

Indications for massive weight loss surgery

The Danish scale for visual rating of massive weight loss (MWL) rates MWL by first, second and third degree. MWL of second (moderate) or third degree (severe) is a criterion for referral to a public hospital in Denmark along with the following criteria: 

Weight A decrease in BMI of at least 15 points and a current BMI < 30kg/m2 
(<34 for simple lipectomy)
TimeAt least 6 months of weight stability after MWL
At least 18 months after a potential bariatric surgery
Individually Substantial psychosocial, functional and/or medical impairment
from excess skin in daily life

Physical: Pain, moisture, maceration, infection
Impaired daily activity, reduced ability to work

Psycosocial: Reduced quality of life, discomfort during activities,
undressing, sexually
General health ASA 1 or 2
Appearance Conspicuous and not age appropriate. It should not simply be a
cosmetic and/or age-related issue 

Contraindications for massive weight loss surgery

Absolute Drug or alcohol abuse 
ASA > 3
Active psychosis (untreated psychiatric diagnosis)
Smoking 6 weeks before and 3 weeks after surgery
Metabolically unstable (GB blood samples), elevated risk of DVT or bleeding, diabetes mellitus 
Relative Continued obesity or excessive amount of subcutaneous fat tissue