Bariatric Surgery Should Not Be The Last Resort

Recent data shows that close to 80 million American are obese. Now considered a chronic disease, obesity is associated with various health conditions and increases one's risk of high blood pressure, high cholesterol, type 2 diabetes, coronary heart disease, stroke, asthma, osteoarthritis, gall bladder disease, sleep apnea, and some cancers. Aside from these medical issues, obesity also raises psychosocial as well as economic problems.

Overweight and Obesity, a Growing Problem

Experts define being overweight as having a body mass index (BMI, a measure of body fat) of 25 to 29. 9 kg/m² while obesity is that of having a BMI of more than 30 kg/m² . It is currently estimated that almost 70% of adults are either overweight or obese. Although the increase in prevalence rates of obesity seems to be slowing down since 2008, the National Health and Nutrition Examination Surveys show that overweight and obesity continues to be a growing problem among some groups of people, including those with low income and less education, and in some ethnic and racial minority groups.

Overweight and obesity significantly contribute to the development of chronic diseases and is a major public health problem. Research shows that obesity increases costs of hospitalization and outpatient services.

Bariatric Surgery as an Option for Treating Obesity

Bariatric surgery is a type of weight loss surgery that has been found to be effective in losing a significant amount of weight in morbidly obese individuals (BMI >40). It has been proven to be safe and effective in improving the health and quality of life of these people. At present, bariatric surgery is recommended only when all other measures such as diet, exercise and medications do not work, especially if a patient is at risk for obesity-related diseases. Current criteria set by the American Society for Bariatric and Metabolic Surgery, American Association of Clinical Endocrinologists, and The Obesity Society recommend bariatric surgery in morbidly obese patients with a BMI of at least 40 or in those with a BMI of at least 35 (severely obese) and one or more comorbid conditions such as diabetes, heart disease or high blood pressure.

Many healthcare providers are now clamoring for change in the current guidelines for managing overweight and obesity. They are strongly suggesting that bariatric surgery must not only used as a last resort for achieving weight loss in morbidly obese patients when all other options have failed.

Health experts usually advise overweight patients to eat a healthy, low calorie, high fiber diet that includes a variety of foods and nutrients to improve their weight and to promote health. They also encourage regular exercise, emphasizing on aerobic and muscle strengthening workouts to burn excess fat and increase fitness. Aside from these, current guidelines for the management of adult overweight and obesity set by the American Heart Association (AHA), American College of Cardiology (ACC), and the Obesity Society focus on the role of primary care physicians in identifying and managing high risk patients. These guidelines emphasize achieving at least a three to five percent weight loss, which could result in improvement of general health.

These guidelines include an algorhythm which calls for dieting, lifestyle interventions (physical activity, behavioral changes), and working with a trained interventionist. Another option to manage excess body fat is to use prescription drugs which can reduce blood cholesterol levels, such as orlistat (Xenical) or appetite suppressants such as phentermine/topiramate (Qsymia) and lorcaserin (Belviq). However, these FDA-approved drugs must not be used alone, but to supplement a healthy diet and lifestyle.

See Also: Obesity: The disease of modern age

What is Bariatric Surgery?

Bariatric surgery refers to a type of procedure that involves creating a small stomach pouch that is then connected to the distal part (further end) of the small intestine. There are different techniques of doing this, but the common end result is to reduce the size of the stomach, which limits one's food intake, and to bypass the first portion of the small intestine where fat and other nutrients are absorbed.

Here are the primary types of bariatric surgery:

1. Gastric Bypass (Roux-en-Y gastric bypass): In this procedure, a small pouch is created at the top of the stomach, which is then directly connected to the small intestine. This bypasses most of the stomach and a portion of the small intestine, resulting in reduced calorie and nutrient absorption.

2. Adjustable Gastric Banding (Lap-Band Surgery): A band is placed around the upper portion of the stomach, creating a small pouch above the band and the rest of the stomach below. The size of the opening from the upper pouch to the rest of the stomach is adjustable, which can control the amount of food the stomach can hold.

3. Gastric Sleeve (Sleeve Gastrectomy): This procedure involves removing a significant portion of the stomach, leaving behind a tubular "sleeve" of stomach. This not only limits the amount of food the stomach can hold but also impacts hunger-regulating hormones in the body.

4. Biliopancreatic Diversion with Duodenal Switch (BPD/DS): This is a two-part surgery. First, a sleeve gastrectomy is performed, and then a large portion of the small intestine is bypassed, resulting in reduced calorie and nutrient absorption.

5. Intragastric Balloon (IGB): This is a less invasive procedure where a balloon is placed inside the stomach and then filled with saline, which can reduce the amount of food the stomach can hold. The balloon is typically removed after six months.