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.

Advantages And Disadvantages Of Bariatric Surgery

Many scientists are now questioning why bariatric surgery is still being used as the last resort in treating morbid obesity, when evidence has clearly shown that it can significantly reduce weight and bring about metabolic benefits. Dr. David Cummings, of the University of Washington in Seattle, believes that the current guidelines for treating obesity are outdated and must consider the benefits of bariatric surgery more carefully.

The advantages of bariatric surgery include:

• Rapid change in weight over a few months

• Significant weight loss (up to 50% of excess weight) is achieved over several months

• Weight loss is much greater than that achieved by non-surgical weight loss programs

• Sustained weight control over many years

• Helps in reducing high cholesterol

• Reduced risk of diabetes, liver disease, high blood pressure, heart disease, stroke, and obstructive sleep apnea.

• Improves low back pain and arthritis

• Improves physical appearance and increases one's self-confidence

• Improves one's ability to do physical activity

• Improves psychosocial aspect of life

• May improve life expectancy

These advantages are believed to outweigh the disadvantages of bariatric surgery, which include:

• Common post-surgical complications, including pain, bleeding, and infection.

• During the first few months, rapid weight loss may result in body reactions such as fatigue, hair loss, body aches, mood changes, and dry skin.

• Need to change eating behaviors, since the small stomach capacity will limit the amount of food one can eat

• One may experience nutritional deficiencies because of inability to absorb nutrients from small intestine.

• Need for lifetime vitamin and mineral supplementation to make up for malabsorption of nutrients.

• Need to make frequent medical consultations and undergo laboratory examinations to monitor health.

• One may need to undergo cosmetic surgery to remove loose skin and improve appearance.

• Gallstone formation is common.

Studies show that compared to the costs of medical treatment for obesity and its related diseases, the cost for bariatric surgery and follow-up treatments is much lower.

See Also: Gastric Bypass Surgery: The Best Slimming method

Candidates for weight-loss surgery are morbidly obese patients and severely obese patients who are at risk for obesity-related diseases such as heart disease, diabetes, high blood pressure, stroke and more. He must be healthy enough to tolerate surgery. Aside from these, the patient must be psychologically stable and must have realistic expectations of the surgery. He must be able to comply with behavioral changes needed to maintain health after the surgery, including changes in diet and going for follow-up check-ups to monitor his health. A supportive family and social environment will help him undergo the many changes that will follow the surgery.

The decision on whether a patient should undergo bariatric surgery to lose weight and prevent obesity-related complications depends on various factors, including the patient's choice and a doctor's assessment of the suitability of the procedure for the individual. However, with the many advantages of weight-loss surgery, doctors must consider bariatric surgery as a strong option rather than as a last resort in the treatment of obesity.