Major updates to 1991 National Institutes of Health guidelines for bariatric surgery 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. Long-term results of MBS consistently demonstrate safety and efficacy. Appropriately selected children and adolescents should be considered for MBS. (Surg Obes Relat Dis 2022; https://doi.org/10.1016/j.soard.2022.08.013) © 2022 American Society for Metabolic and Bariatric Surgery. All rights reserved.