Minister of Health: Regulation of Bariatric Surgeries and Non-Surgical Interventional Procedures in the Public and Private Sectors

AbdulKarim Al-Abdullah: Minister of Health Dr. Ahmed Al-Awadi issued Ministerial Decision No. 221 of 2026 concerning the requirements, regulations, and standards to be adhered to when performing obesity surgeries and non-surgical interventional procedures in healthcare facilities in both the public and private sectors. This establishes a comprehensive regulatory framework for these practices, based on clear standards covering the healthcare facility, the practitioner, patient selection, evaluation and follow-up mechanisms, and the monitoring of outcomes and complications.

The decision defines the scope of bariatric and metabolic surgeries, classifying them into primary, revisional, and malabsorptive procedures, while also regulating non-surgical interventional procedures, including Endoscopic Sleeve Gastroplasty (ESG) and Intragastric Balloon (IGB), specifying the requirements and standards for each category.

The decision sets clear criteria for selecting candidates for primary bariatric surgery, recommending it for individuals with a Body Mass Index (BMI) of 35 kg/m² or higher. It may also be considered for those with a BMI between 30 and 34.9 kg/m² who have at least one obesity-related comorbidity, with a recommendation to utilize non-surgical treatment options before considering surgical intervention.

The decision specifies the approved primary surgical procedures, which include sleeve gastrectomy, classic gastric bypass, single-anastomosis duodenal switch (mini-gastric bypass), and gastric banding. It states that there is no fixed upper age limit for obesity surgeries, with eligibility determined based on the patient’s overall health status.

In the context of establishing more precise regulations for younger age groups, the decision permits the consideration of bariatric surgery for selected children and adolescents aged 12 to 17, according to specific criteria, following a comprehensive evaluation and approval by a multidisciplinary team (MDT), and with informed written consent from parents or legal guardians. Strict adherence to medical follow-up for at least two years post-surgery is required. Specific BMI and comorbidity criteria were established for this group, restricting recommended procedures primarily to sleeve gastrectomy and gastric bypass in specific cases.

The decision also regulates revisional surgeries and malabsorptive procedures, defining the cases in which revisional surgery is permissible, such as weight regain or insufficient weight loss after previous bariatric surgery, inadequate improvement in comorbidities, or the management of certain complications like severe gastroesophageal reflux disease. It mandates that cases for revisional and malabsorptive surgeries be presented to a multidisciplinary team for official and documented approval prior to the procedure.

Regarding malabsorptive procedures, the decision stipulates that they are not permitted as primary interventions and must be performed exclusively by an expert surgeon with proven experience in the specific procedure, thereby enhancing patient safety and ensuring that more complex procedures are entrusted to qualified experts.

The decision also regulates non-surgical interventional obesity procedures, classifying endoscopic sleeve gastroplasty and intragastric balloon under this category, and establishing specific standards for them. These include a BMI of 27 kg/m² or higher as a primary weight loss option, or 50 kg/m² or higher as a preoperative treatment before final surgery. These procedures must be performed by a qualified bariatric surgeon or a certified and trained gastroenterologist specializing in endoscopic obesity procedures, and are not to be performed on individuals under 18 years of age.

Regarding healthcare facilities, the decision restricts the performance of bariatric surgeries to government hospitals or licensed and accredited private hospitals. For private hospitals, it requires appropriate infrastructure, including intensive care units, medical imaging services, and laboratory services, alongside comprehensive pre-surgical evaluation protocols.

In a significant move to enhance governance and oversight of clinical outcomes, the decision mandates the immediate reporting of severe complications classified as grade 3 or higher according to the Clavien-Dindo classification, as well as cases of death. It establishes specific reporting pathways for both the public and private sectors. Additionally, it provides for the creation and maintenance of a national registry for bariatric surgeries, encompassing all cases, outcomes, and complications, to support the monitoring of practice quality and the evaluation of results at the national level.

The decision also regulates the transfer of patients from private to government hospitals, emphasizing adherence to the patient transfer policy approved by the Ministry of Health, and requiring the attachment of all medical reports and test results, along with the registration of the surgical procedure and/or surgical notes within a period not exceeding 24 hours.

The decision sets clear requirements for the professional qualifications of physicians, stipulating that the surgeon must be a senior specialist or consultant in general surgery and hold certified training or qualifications in bariatric surgery, in accordance with the regulations outlined in the decision. It also obligates surgical departments to maintain and periodically approve updated lists of surgeons with expertise in this field. Furthermore, it regulates the practice of visiting surgeons, their licensing procedures, and the approval of procedures they wish to perform.

The decision applies its requirements, regulations, and standards to both the public and private sectors, allowing for the future updating of these standards based on modern scientific evidence and developments in healthcare standards. This ensures alignment with scientific advancements in bariatric surgery and non-surgical interventional procedures, enhancing the quality of care, patient safety, and the efficiency of healthcare practice.