The Metabolic and Bariatric Surgery Focused Practice Designation, developed by the American Board of Surgery with the American Society for Metabolic and Bariatric Surgery, is examined as a single written paper of roughly 150 questions across two 120-minute sessions. Sixty per cent of the paper sits in preoperative assessment and postoperative management — the two areas where candidates most often lose marks. Practise with questions mapped to that published content outline.
Content reviewed 26 August 2026 against current guidelines.
Start practising freeTaken from the bank, not written for this page. Answer it in your head, then open the explanation.
A 40-year-old man with BMI 38 kg/m² presents requesting bariatric surgery. He has no comorbidities — no T2DM, no hypertension, no OSA, no dyslipidaemia. He reports excellent functional capacity, no joint pain, and normal routine blood tests. He has been obese since age 22 and has failed multiple diet and exercise programmes. He has no psychiatric history. He seeks surgery purely for quality-of-life improvement and long-term health risk reduction. Under ASMBS/IFSO 2022 guidelines, is he eligible for bariatric surgery?
Correct answer: B
This is a critical question that tests understanding of the 2022 ASMBS/IFSO guideline change from the historical BMI-with-comorbidity framework. The **ASMBS/IFSO 2022 Updated Indications** represent a fundamental paradigm shift: **Old framework (pre-2022)**: - BMI ≥40: surgery indicated regardless of comorbidities - BMI 35-39.9: surgery indicated ONLY if at least one qualifying comorbidity is present - BMI 30-34.9: surgery considered only for T2DM in specific circumstances **New 2022 framework**: - BMI ≥35: MBS is recommended **regardless of the presence or absence of comorbidities** - This reflects the understanding that severe obesity (BMI ≥35) itself constitutes sufficient indication — it is associated with >30-year actuarial life expectancy reduction, independent of diagnosed comorbidities - The condition-based threshold is removed from the ≥35 tier - BMI ≥30 with inadequately controlled metabolic disease: MBS recommended Rationale for the change: 1. Obesity itself (independent of diagnosed comorbidities) is associated with premature cardiovascular death, cancer, renal failure, musculoskeletal disease, and psychosocial harm 2. Many patients with BMI 35-40 have subclinical or undiagnosed comorbidities 3. Prevention of future comorbidities (T2DM onset prevented in 80% of at-risk patients with MBS) is a valid healthcare goal 4. Evidence demonstrates bariatric surgery reduces all-cause mortality even in patients without baseline comorbidities This patient (BMI 38, no comorbidities, failed lifestyle) qualifies under 2022 guidelines for MBS. No procedure restriction applies to comorbidity-free patients. Important caveat: Many national health systems and insurers have not yet adopted the 2022 guidelines — local funding criteria may still require comorbidities. However, the clinical guideline position is clear. Guideline reference: ASMBS/IFSO 2022 Updated Indications. Surg Obes Relat Dis 2022.
Teaching point. 2022 ASMBS/IFSO guidelines: BMI ≥35 = indication regardless of comorbidities. The old 'BMI 35-40 requires comorbidity' rule is removed. Prevention of future comorbidities + overall mortality reduction are valid surgical goals. Local funding criteria may lag behind clinical guidelines.
Referenced to ASMBS/IFSO 2022 Updated Indications for MBS
Every question is explained like this — start with 50 free ›Every question is written by Pablo Lozano Lominchar, MD, PhD, and mapped to this board’s published syllabus. Before it enters the bank it has to pass an automated check: five options, a written explanation, and a citation — a named society guideline or a named trial. Benign and functional topics cannot be published without a society guideline; oncological ones cite NCCN, ESMO or AJCC, and the classification systems that govern a topic — Bethesda, TIRADS, Atlanta, Prague, Chicago — have to appear where they apply. The author has audited the full active bank against current guideline versions: what fails is re-cited, rewritten or withdrawn. 650 questions are currently withdrawn and are served to nobody.
Scope of authorship. MBS FPD sits outside the author’s own subspecialty practice, which is surgical oncology — peritoneal malignancy, sarcoma, hepatopancreatobiliary and complex pelvic surgery. No diplomate of this board has signed these questions off. What they offer is traceability rather than personal authority: every answer names the current guideline or trial it rests on, so you can check it at the source before you trust it. Found an error? Tell us — it gets corrected or withdrawn.
It is a single written examination of approximately 150 multiple-choice questions lasting about four and a half hours, delivered as two 120-minute sessions. It is offered once a year in the spring, and candidates have a maximum of three attempts within five years.
The published content outline weights preoperative assessment and management at 30 per cent, postoperative assessment and management including complications, weight regain and recurrence at 30 per cent, operations and interventions at 25 per cent, the science of obesity and metabolic disease at 7.5 per cent, and special populations including age-specific groups, comorbidities and pregnancy at 7.5 per cent.
Surgeons currently certified by the American Board of Surgery or the American Osteopathic Board of Surgery and compliant with continuous certification, with a sustained metabolic and bariatric practice meeting the board case-volume and stapling requirements, practising at an accredited metabolic and bariatric surgery centre.
SurgBoardsQ&A provides 1,049 metabolic and bariatric surgery practice questions covering selection, operative technique, postoperative complications, revisional surgery and metabolic physiology, each with a guideline-referenced explanation.
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