Focused Practice Designation
The Metabolic and Bariatric Surgery Focused Practice Designation was developed by the American Board of Surgery with the American Society for Metabolic and Bariatric Surgery. It is not a subspecialty board certificate; it is a designation that recognises surgeons whose practice is genuinely concentrated in metabolic and bariatric surgery. This guide covers the examination, the published content weights and how to prepare against them.
A Focused Practice Designation recognises diplomates who have focused their practice on one particular aspect of a field. The American Board of Surgery currently offers two: metabolic and bariatric surgery, and adult complex thyroid and parathyroid surgery.
The designation covers the comprehensive care of patients treated for obesity and metabolic disease — primary and revisional bariatric surgery, management of bariatric complications, and bariatric endoscopy. It is achieved by meeting practice and case requirements and by passing a written examination.
From the 2025 examination onwards, surgeons certified by either the American Board of Surgery or the American Osteopathic Board of Surgery meet the same eligibility requirements and sit the same examination.
Written Examination
The published content outline weights preoperative assessment at 30 per cent and postoperative management at 30 per cent. Sixty per cent of the paper therefore sits outside the operation itself, which is the opposite of how most candidates instinctively revise.
Preoperative Assessment and Management — 30%
Indications and contraindications, anaesthetic considerations, preoperative and endoscopic assessment, and the components of a metabolic and bariatric surgery centre.
Postoperative Assessment and Management — 30%
Routine postoperative care, early and late complications, revisional surgery for complications and for weight regain, and pharmacotherapy.
Operations and Interventions — 25%
Reconstruction of the gastrointestinal tract, the methods and results of each procedure, and how surgical devices work, including their safety and efficacy.
Science of Obesity and Metabolic Disease — 7.5%
Epidemiology of obesity and weight-related discrimination, and the pathophysiology of obesity and obesity-related disease.
Special Populations — 7.5%
Age-specific populations including adolescents and older patients, comorbidities, and pregnancy.
The examination is offered once a year in the spring, with the application window closing several months beforehand.
Dates, fees, case-volume thresholds and accreditation requirements change between cycles — confirm the current requirements with the American Board of Surgery (absurgery.org) before applying.
Metabolic and bariatric surgery has become a distinct practice with its own complication profile, its own revisional decision-making and, increasingly, its own pharmacological competition. The designation is how a surgeon demonstrates that their practice and knowledge are genuinely concentrated there rather than occasional.
Preparing for it has a direct clinical return: the examination weights complications and revisional decision-making heavily, and those are precisely the situations where a bariatric practice either protects patients or does not.
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 987 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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50 questions free, no credit card required. Filter by board, topic, or difficulty. Explanations cite ESMO and NCCN.