Obesity has reached epidemic proportions, affecting one third of the U.S. population. It has serious physical, psychological, social and economic implications. It impacts every organ system-cardiovascular, genito-urinary, endocrine, gastrointestinal, musculoskeletal, and pulmonary. U.S. Preventative Services Task Force recommends that everyone get screened and those with a BMI of 30 or greater be offered multi component interventional services.
The USPSTF said these programs commonly include group sessions (at least 12 or more in the first year) and help patients make healthy eating choices, encourage them to increase physical activity and help them monitor their own weight. “Of the programs we examined, those that combined multiple activities and included group sessions had the strongest effect,” said task force member Chyke Doubeni, M.D., M.P.H., in the release. “Evidence shows that people regain less weight and had clinically significant weight loss of 5% or more with these interventions.
Surgical treatment of obesity can result in greater weight loss, greater reduction in comorbidities, and prolonged survival compared with nonsurgical interventions. Bariatric surgery (or weight loss surgery) includes a variety of procedures. Weight loss is achieved by reducing the size of the stomach with a gastric band or through removal of a portion of the stomach (sleeve gastrectomy or biliopancreatic diversion with duodenal switch) or by resecting and re-routing the small intestine to a small stomach pouch (gastric bypass surgery).
Gastric bypass and other weight-loss surgeries make changes to your digestive system. Doing so helps you lose weight by limiting how much you can eat or by reducing the absorption of nutrients, or both. Gastric bypass and other weight-loss surgeries are done when diet and exercise haven’t worked, or when you have serious health problems that have not been controlled by any other means.
Worldwide, more than 340,000 bariatric procedures were performed in 2011. According to the American Society for Metabolic and Bariatric Surgery, about 179,000 were performed in the United States in 2013. Eligibility criteria were established by the 1991 National Institutes of Health Consensus Development Conference Panel and have changed little in the ensuing years.
Selection and Exclusion Criteria for Bariatric Surgery:
- Able to adhere to postoperative care (e.g., follow-up visits and tests, medical management, use of dietary supplements)
- BMI equal or greater than 40 without coexisting medical issues
- BMI equal or greater than 35 with one or more severe obesity related diseases
- BMI 30 to 34.9 with diabetes mellitus or metabolic syndrome (see post)
- Cardiopulmonary disease that would make the risk prohibitive
- Current drug or alcohol abuse
- Lack of comprehension of risks, benefits, expected outcomes, alternatives, and required lifestyle changes
- Reversible endocrine or other disorders that can cause obesity
- Uncontrolled, severe psychiatric illness
The surgical procedure chosen depends on underlying medical conditions, patient preference, and expertise of the surgeon. Recent emphasis has shifted from not only weight loss outcomes but also the metabolic effects of these surgical procedures.
On average, weight loss of 60% to 70% of excess body weight is achieved in the short term, and up to 50% at 10 years. Remission of type 2 diabetes mellitus occurred in 60% to 80% of patients two years after surgery and persisted in about 30% of patients after 15 years. Other obesity-related issues were also greatly reduced, and health-related quality of life improved.
Surgery is not a weight loss panacea. Prior to any procedure, each patient must undergo a rigorous evaluation that includes a complete history and physical examination:
- Attention to obesity-related diseases (i.e. diabetes and heart disease)
- Review of weight loss–attempt history
- Three to six months of medical weight management
- Pychosocial, behavioral, and nutrition evaluations
- Laboratory studies
- The purpose of this evaluation is to identify and optimally manage conditions that may negatively affect the surgical period and increase the possibility of post surgical problems.
Overall, these procedures have a mortality risk of less than 0.5%. Studies have shown that bariatric surgery reduces all-cause mortality by 30% to 50% at 7-15 years post surgery compared with patients with obesity who did not have surgery. Still, all forms of weight-loss surgery, including gastric bypass, are major surgical procedures that can pose serious risks and side effects. It is imperative that permanent life style changes be made, including maintaining a healthy diet and getting regular exercise, to help ensure the long-term success of bariatric surgery. Otherwise your benefits may be minimal to none.
I’ve had several patients undergo gastric surgery as a last hope effort to finally lose the weight they’ve been fighting their whole lives. Most are still doing well. But others fell back in to their old habits and found ways around their stomachs physical limitations- such as eating high calorie foods like ice cream. The physical procedure definitely helped reduce the pounds but the multitude of other concerns that combine to impact weight still required daily vigilance to overcome.
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