Current Status and Issues Associated with Bariatric and Metabolic Surgeries in Japan

Among Asian countries, laparotomic and laparoscopic bariatric surgeries were introduced in Japan after its establishment in Taiwan. However, in spite of high prevalence of potential diabetic obese patients, especially at a lower BMI, the wider incorporation of surgery into treatment regimen has been stalling for decades in Japan and has even fallen behind advanced Asian countries. While the unique Japanese national health insurance system has guaranteed fair healthcare delivery and quality of surgery to every citizen, it might have worked as a barrier to the development of bariatric and metabolic surgery (BMS) in the country. Now, we are facing many challenges to accomplish our ideal goal of removing obesity bias and offering proper indications for BMS and the choice of surgical procedures based on individual patient’s needs. The present article reviews the status of BMS in Japan and discusses recent issues related to its use. To focus on and identify the major obstacles inhibiting the widespread use of BMS in Japan, we have comprehensively covered some major areas including insurance system, surgical indication and type, accreditation and training system, original research, and national registry.