Pre-Bariatric Surgery Comprehensive Profile

CPT: 80053; 80061; 82306; 82390; 82525; 82607; 82728; 82746; 83036; 83540; 83550; 83921; 84425; 84443; 84466; 84590; 84630; 85027
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Synonyms

  • Weight Management

Test Includes

Vitamin B1, vitamin B12, methylmalonic acid, folate, ferritin, iron and total iron-binding concentration (TIBC), transferrin saturation, 25-hydroxyvitamin D, vitamin A, zinc, copper, ceruloplasmin, FIB-4, complete blood count (CBC), comprehensive metabolic panel (CMP), thyroid-stimulating hormone (TSH), lipid panel, hemoglobin A1c


Expected Turnaround Time

5 - 7 days


Specimen Requirements


Specimen

Serum, whole blood, plasma


Volume

5 mL serum, 8 mL whole blood, 4 mL plasma


Container

Gel-barrier tube, polypropylene screw-capped transfer tube, trace metal free transfer tube, lavender-top (EDTA) tube


Storage Instructions

See individual test components.


Test Details


Use

Obesity, associated with a multitude of co-morbid conditions, is a serious health condition impacting a significant number of patients in the U.S. Per the Centers for Disease Control and Prevention (CDC), the prevalence of obesity in the U.S. increased from 30.5% in 1999-2000 to 41.9% in 2017- March 2020.1 Currently, there is great emphasis on being overweight and obesity as a disease, with societies providing guidance on the use of newly available pharmacologic therapies as well as bariatric surgical procedures to decrease the burden.

Depending upon the type of bariatric surgery performed, deficiencies of micronutrients and some vitamins may ensue, and recommendations are to evaluate these parameters prior to surgery and at least annually thereafter.


Limitations

See individual test components.


Methodology

See individual test components.


Additional Information

Per 2019 guidelines,2 bariatric surgery is advised under the following conditions in adult populations:

Patients with a body mass index ≥40 kg/m2 without co-existing medical problems and for whom bariatric procedures would not be associated with excessive risk are eligible for a bariatric procedure (Grade A; BEL 1).

Patients with a body mass index (BMI) ≥35 kg/m2 and one or more severe obesity-related complications remediable by weight loss, including type 2 diabetes (T2D), high risk for T2D (insulin resistance, prediabetes and/or metabolic syndrome), poorly controlled hypertension, nonalcoholic fatty liver disease/nonalcoholic steatohepatitis, obstructive sleep apnea, osteoarthritis of the knee or hip and urinary stress incontinence, should be considered for a bariatric procedure (Grade C; BEL 3).

Patients with the following comorbidities and BMI ≥35 kg/m2 may also be considered for a bariatric procedure, hypoventilation syndrome and Pickwickian syndrome after a careful evaluation of operative risk: idiopathic intracranial hypertension; gastroesophageal reflux disease; severe venous stasis disease; impaired mobility due to obesity and considerably impaired quality of life (Grade C; BEL 3).

Patients with body mass index 30 to 34.9 kg/m2 and type 2 diabetes with inadequate glycemic control despite optimal lifestyle and medical therapy should be considered for a bariatric procedure; current evidence is insufficient to support recommending a bariatric procedure in the absence of obesity (Grade B; BEL 2).

The body mass index criterion for bariatric procedures should be adjusted for ethnicity (e.g., 18.5 to 22.9 kg/m2 is normal range, 23 to 24.9 kg/m2 is overweight and ≥25 kg/m2 is obesity for Asians) (Grade D).

Bariatric procedures should be considered to achieve optimal outcomes regarding health and quality of life when the amount of weight loss needed to prevent or treat clinically significant ORC cannot be obtained using only structured lifestyle change with medical therapy (Grade B; BEL 2).

Grading of these guidelines corresponds to the following levels of recommendation (BEL: best evidence level):

• Grade A / BEL 1 – strong recommendation

• Grade B / BEL 2 – intermediate recommendation

• Grade C / BEL 3 – weak recommendation

• Grade D – no conclusive evidence or expert opinion

The following indications for bariatric surgery3 are suggested by the 2022 American Society for Metabolic and Bariatric Surgery (ASMBS) and International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO):

• Metabolic and bariatric surgery (MBS) is recommended for individuals with a body mass index (BMI) ≥35 kg/m2, regardless of presence, absence or severity of co-morbidities.

• MBS should be considered for individuals with metabolic disease and BMI of 30-34.9 kg/m2.

• BMI thresholds should be adjusted in the Asian population such that a BMI ≥25 kg/m2 suggests clinical obesity, and individuals with BMI ≥ 27.5 kg/m2 should be offered MBS.


Footnotes

1. Adult Obesity Facts. Centers for Disease Control and Prevention (CDC) website: https://www.cdc.gov/obesity/data/adult.html. Updated May 17, 2022. Accessed Dec 19, 2023.
2. Mechanick JI, Apovian C, Brethauer S, et al. Clinical Practice Guidelines for the perioperative nutrition, metabolic, and nonsurgical support of patients undergoing bariatric procedures - 2019 update: Cosponsored by American Association of Clinical Endocrinologists/American College of Endocrinology, The Obesity Society, American Society for Metabolic & Bariatric Surgery, Obesity Medicine Association, and American Society of Anesthesiologists. Endocr Pract. 2019 Dec;25(12):1346-1359.31682518
3. Eisenberg D, Shikora SA, Aarts E, et al. 2022 American Society for Metabolic and Bariatric Surgery (ASMBS) and International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO): Indications for Metabolic and Bariatric Surgery. Surg Obes Relat Dis. 2022 Dec;18(12):1345-1356.36280539

References

Banerjee ES, Schroeder R, Harrison TD. Metabolic Surgery for Adult Obesity: Common Questions and Answers. Am Fam Physician. 2022 Jun 1:105(6):593-601.35704821

LOINC® Map

Order Code Order Code Name Order Loinc Result Code Result Code Name UofM Result LOINC
259141 CMP14+LP+Fe+TSH+TIBC+Fer+Hb... 001032 Glucose mg/dL 2345-7
259141 CMP14+LP+Fe+TSH+TIBC+Fer+Hb... 001481 Hemoglobin A1c % 4548-4
259141 CMP14+LP+Fe+TSH+TIBC+Fer+Hb... 001040 BUN mg/dL 3094-0
259141 CMP14+LP+Fe+TSH+TIBC+Fer+Hb... 001370 Creatinine mg/dL 2160-0
259141 CMP14+LP+Fe+TSH+TIBC+Fer+Hb... 001198 Sodium mmol/L 2951-2
259141 CMP14+LP+Fe+TSH+TIBC+Fer+Hb... 001180 Potassium mmol/L 2823-3
259141 CMP14+LP+Fe+TSH+TIBC+Fer+Hb... 001206 Chloride mmol/L 2075-0
259141 CMP14+LP+Fe+TSH+TIBC+Fer+Hb... 001578 Carbon Dioxide, Total mmol/L 2028-9
259141 CMP14+LP+Fe+TSH+TIBC+Fer+Hb... 001016 Calcium mg/dL 17861-6
259141 CMP14+LP+Fe+TSH+TIBC+Fer+Hb... 001073 Protein, Total g/dL 2885-2
259141 CMP14+LP+Fe+TSH+TIBC+Fer+Hb... 001081 Albumin g/dL 1751-7
259141 CMP14+LP+Fe+TSH+TIBC+Fer+Hb... 012039 Globulin, Total g/dL 10834-0
259141 CMP14+LP+Fe+TSH+TIBC+Fer+Hb... 012047 A/G Ratio 1759-0
259141 CMP14+LP+Fe+TSH+TIBC+Fer+Hb... 001099 Bilirubin, Total mg/dL 1975-2
259141 CMP14+LP+Fe+TSH+TIBC+Fer+Hb... 001107 Alkaline Phosphatase IU/L 6768-6
259141 CMP14+LP+Fe+TSH+TIBC+Fer+Hb... 001123 AST (SGOT) IU/L 1920-8
259141 CMP14+LP+Fe+TSH+TIBC+Fer+Hb... 001545 ALT (SGPT) IU/L 1742-6
259141 CMP14+LP+Fe+TSH+TIBC+Fer+Hb... 011582 FIB-4 Index N/A
259141 CMP14+LP+Fe+TSH+TIBC+Fer+Hb... 001347 Iron Bind.Cap.(TIBC) ug/dL 2500-7
259141 CMP14+LP+Fe+TSH+TIBC+Fer+Hb... 001348 UIBC ug/dL 2501-5
259141 CMP14+LP+Fe+TSH+TIBC+Fer+Hb... 001339 Iron ug/dL 2498-4
259141 CMP14+LP+Fe+TSH+TIBC+Fer+Hb... 011362 Iron Saturation % 2502-3
259141 CMP14+LP+Fe+TSH+TIBC+Fer+Hb... 004598 Ferritin ng/mL 2276-4
259141 CMP14+LP+Fe+TSH+TIBC+Fer+Hb... 001560 Ceruloplasmin mg/dL 2064-4
259141 CMP14+LP+Fe+TSH+TIBC+Fer+Hb... 142004 Vitamin A ug/dL 2923-1
259141 CMP14+LP+Fe+TSH+TIBC+Fer+Hb... 121188 Vit. B1, Whole Blood nmol/L 32554-8
259141 CMP14+LP+Fe+TSH+TIBC+Fer+Hb... 001503 Vitamin B12 pg/mL 2132-9
259141 CMP14+LP+Fe+TSH+TIBC+Fer+Hb... 002020 Folate (Folic Acid), Serum ng/mL 2284-8
259141 CMP14+LP+Fe+TSH+TIBC+Fer+Hb... 081953 Vitamin D, 25-Hydroxy ng/mL 62292-8
259141 CMP14+LP+Fe+TSH+TIBC+Fer+Hb... 004937 Transferrin mg/dL 3034-6
259141 CMP14+LP+Fe+TSH+TIBC+Fer+Hb... 001065 Cholesterol, Total mg/dL 2093-3
259141 CMP14+LP+Fe+TSH+TIBC+Fer+Hb... 001172 Triglycerides mg/dL 2571-8
259141 CMP14+LP+Fe+TSH+TIBC+Fer+Hb... 011817 HDL Cholesterol mg/dL 2085-9
259141 CMP14+LP+Fe+TSH+TIBC+Fer+Hb... 011919 VLDL Cholesterol Cal mg/dL 13458-5
259141 CMP14+LP+Fe+TSH+TIBC+Fer+Hb... 012059 LDL Chol Calc (NIH) mg/dL 13457-7
259141 CMP14+LP+Fe+TSH+TIBC+Fer+Hb... 011923 LDL Calc Comment: N/A
259141 CMP14+LP+Fe+TSH+TIBC+Fer+Hb... 004264 TSH uIU/mL 11580-8
259141 CMP14+LP+Fe+TSH+TIBC+Fer+Hb... 001586 Copper, Serum or Plasma ug/dL 5631-7
259141 CMP14+LP+Fe+TSH+TIBC+Fer+Hb... 001800 Zinc, Plasma or Serum ug/dL 5763-8
259141 CMP14+LP+Fe+TSH+TIBC+Fer+Hb... 706797 Methylmalonic Acid, Serum nmol/L 13964-2
259141 CMP14+LP+Fe+TSH+TIBC+Fer+Hb... 005025 WBC x10E3/uL 6690-2
259141 CMP14+LP+Fe+TSH+TIBC+Fer+Hb... 005033 RBC x10E6/uL 789-8
259141 CMP14+LP+Fe+TSH+TIBC+Fer+Hb... 005041 Hemoglobin g/dL 718-7
259141 CMP14+LP+Fe+TSH+TIBC+Fer+Hb... 005058 Hematocrit % 4544-3
259141 CMP14+LP+Fe+TSH+TIBC+Fer+Hb... 015065 MCV fL 787-2
259141 CMP14+LP+Fe+TSH+TIBC+Fer+Hb... 015073 MCH pg 785-6
259141 CMP14+LP+Fe+TSH+TIBC+Fer+Hb... 015081 MCHC g/dL 786-4
259141 CMP14+LP+Fe+TSH+TIBC+Fer+Hb... 105007 RDW % 788-0
259141 CMP14+LP+Fe+TSH+TIBC+Fer+Hb... 015172 Platelets x10E3/uL 777-3
259141 CMP14+LP+Fe+TSH+TIBC+Fer+Hb... 015945 NRBC % 58413-6
259141 CMP14+LP+Fe+TSH+TIBC+Fer+Hb... 100779 eGFR mL/min/1.73 98979-8

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