Following a number of deaths and near-deaths in recent years among people who
have undergone bariatric surgery to treat severe obesity by reducing the size of
their stomachs, the Health Ministry has issued new directives to better regulate
Prof. Arnon Afek, the head of the ministry’s medical
administration, wrote – in a document aimed at all relevant authorities – that
Israel is one of 10 countries in the world with a significant increase in
obesity. It has multiplied three-fold in the past 30 years, he said.
result, the number of stomach reducing operations – which are included in the
basket of health services if conducted for medical rather than aesthetic
purposes – has also increased.
The operations are also effective in
relieving and often curing Type 2 diabetes.
Afek’s document defines the
minimum criteria necessary for medical centers to be allowed to perform
bariatric surgery. They must set down guidelines on patient assessment and
institutional reporting. It also determined what medical indications there are
for performing the surgery on adults over 18.
Such centers must have a
multidisciplinary team with experts on morbid obesity and its complications, so
they can assess each case. They also need a clinical dietitian; a psychiatrist,
psychologist or social worker; an endocrinology and diabetes service; a
gastroenterological institute and a general intensive care unit and CT and other
imaging and invasive radiology institutes.
In addition, the bariatric
surgery center must be run by a general surgeon whose main activity has been
treatment of the morbidly obese during the previous three years.
center must conduct a minimum of 100 bariatric operations annually and have
expertise in at least two surgical techniques. It must also transfer data to the
National Center for Disease Control.
Surgeons must know how to perform
repair surgery in case a problem arises from the original operation.
wide variety of medical tests must be performed before the would-be patient
undergoes the operation, Afek said.
The dietitian, who must have
experience with bariatric patients, has to make an assessment of the person’s
eating habits, willingness to undergo change, previous attempts at weight loss
and reasons for failure. The stages before and after surgery must be explained
to the patient and expectations for positive results must be
Any candidate for bariatric surgery must say whether he is
currently undergoing psychiatric treatment. He also needs a statement from his
psychiatrist’s that he is able to cope with the surgery and its
A multidisciplinary discussion must be held with regards to
patients that are 65 years old and over, to consider the medical implications of
such an operation.
Once the surgery is performed, the medical institution
must follow up in the community with at least six sessions during the first year
after the operation.
Just reducing the stomach is not enough; lifestyle
changes must be made, Afek wrote.
In the second year, one to three
follow- up sessions must be held, either in person or online.
physician must also send the patient for medical tests including blood sugar,
lipid levels and bone density.