Post Bariatric Hypoglycemia (PBH) was once described as rare. It is not.

Earlier estimates suggested rates near 1%. Today, more sensitive tools tell a different story. Continuous glucose monitoring studies—including Kefurt et al. (2015, Obesity Surgery) and Lupoli et al. (2022, Nutrition, Metabolism & Cardiovascular Diseases)—demonstrate that over 50% of patients experience hypoglycemia following bariatric surgery.

This is not a rare complication.
It is a systematically under-recognized condition.

Symptoms range from fatigue to severe hypoglycemic episodes, including loss of consciousness and, in some cases, seizure. For some patients, this creates real risks of falls, motor vehicle accidents, and loss of independence.

Many patients report they were never warned this could happen before surgery. They are left managing a condition that can be chronic, unpredictable, and disabling—without clear diagnostic standards, consistent treatment guidance, or reliable access to care.

Post-bariatric hypoglycemia is not one condition with one presentation.
It exists on a spectrum, from mild symptoms to severe, life-altering disease.

At the same time, prior clinical guidance has used terms such as “rare” and “uncommon.” Current evidence and patient experience show that these descriptions no longer reflect reality.

What We Are Asking For
We are calling on the American Society for Metabolic and Bariatric Surgery and partner organizations (listed below) to take the following specific actions:

1. Publish an Updated Position Statement by May 2027
Reflect current evidence and CGM-based detection rates
Discontinue use of outdated descriptors such as “rare”
Recognize PBH as a clinically significant condition
Define PBH as a spectrum disorder with variable severity
 
2. Establish a Recognized Diagnostic Code for PBH
Support development and adoption of an appropriate diagnostic classification (e.g., ICD coding)
Ensure PBH can be formally diagnosed, documented, and tracked
Enable accurate epidemiologic data collection and clinical recognition
 
3. Require Clear Preoperative Risk Disclosure
All bariatric patients should be explicitly informed that:

PBH is a known complication of surgery
It may be chronic, severe, and functionally impairing
It can impact safety, cognition, and daily functioning
 
4. Develop Standardized Diagnostic Guidelines
Define clear criteria for diagnosis
Incorporate use of continuous glucose monitoring (CGM)
Establish differentiation from dumping syndrome and other conditions
Provide guidance on when further endocrine evaluation is required
 
5. Establish Evidence-Based Treatment Guidelines
Provide standardized pathways for:

Medical nutrition therapy
Pharmacologic treatment
Surgical intervention when clinically indicated
Long-term management strategies
 
6. Recommend Routine and Annual Screening
Establish expectations for ongoing monitoring after bariatric surgery
Include annual screening for hypoglycemia symptoms
Ensure timely identification and intervention
 
7. Define Referral Standards
Establish clear criteria for referral to endocrinology
Support coordinated, multidisciplinary care
 
8. Advocate for Insurance Coverage of Medically Necessary Care
Support access to:

Continuous glucose monitors (CGMs)
Glucose testing supplies
Medications used to manage PBH
Surgical treatment when medically indicated
PBH should not be excluded from coverage simply because it is not classified as diabetes.

 
9. Recognize Functional Impact and Disability
Acknowledge that PBH may:

Limit the ability to work
Affect driving safety
Require clinical documentation for disability accommodations
 
10. Provide Continuing Education for Bariatric Providers
Ensure providers are trained to:

Recognize PBH
Diagnose it accurately
Treat it effectively
Understand its potential severity and variability
 
11. Convene a Patient Listening Session
Bring together:

Patients
Bariatric clinicians
Endocrinology experts
To ensure that clinical guidance reflects real-world patient experience.

 
12. Establish an Interdisciplinary Committee
Form a working group with partner organizations to:

Align standards across specialties
Improve coordination of care
Oversee implementation of updated guidance
 
13. Sponsor and Support Research
Fund research on PBH prevalence, mechanisms, and treatment
Support multicenter and longitudinal studies
Prioritize patient-centered outcomes

 

14. Collaborate with Partners on this Issue

American Association of Clinical Endocrinology
American Diabetes Association
Metabolic & Bariatric Surgery Accreditation & Quality Improvement Program
American College of Surgeons
Obesity Medicine Association

Why This Matters
Post-bariatric hypoglycemia is already affecting patients.
It is already measurable.
It is already impacting safety and quality of life.

What has changed is not the condition—
it is our ability to detect it.

Clinical standards must now reflect what is known.

 
Add Your Name
If you have experienced post-bariatric hypoglycemia—or believe patients deserve accurate information, recognition, and care—please sign this petition.

This is how recognition begins.
This is how standards change.