Surgical Treatment of the Obese Individual
G. Michael Steelman, Eric C. Westman in Obesity, 2016
A discussion of the current treatment of obesity is not complete without a review of the surgical options. Bariatric surgery is the term used for the surgical treatment of obesity. The number of bariatric surgery operations has climbed steadily over the past 10 years to represent 193,000 cases in 2014. In recent reviews, Buchwald et al. (1,2) outline the research that demonstrates the reduction in obesity-related morbidity and mortality with the use of bariatric surgery. The bariatric surgery literature gives the best published view of how health can improve with weight loss. For example, hypertension is reduced or eliminated in 78.5% of patients, hyperlipidemia in 70% of patients, and obstructive sleep apnea is improved in 83.6% of patients. Analyses have now been published that show a reduction in mortality compared to usual care treatments. When compared with control groups that do not achieve substantial weight loss, there is a reduction in mortality in those who had bariatric surgery. In a retrospective study of 7900 patients with an average follow-up of 7.1 years, the mortality reduction at 7.1 years was 40%, including a 56% reduction in death from coronary artery disease, a 92% reduction in death from diabetes mellitus, and a 60% reduction in deaths from cancer. The overall reduction in mortality over a 10.9-year period was 29% (3,4).
Surgery for Severe Obesity
James M. Rippe in Lifestyle Medicine, 2019
Bariatric surgery is an effective and acceptable treatment for individuals with severe obesity who are at risk for or have complications associated with obesity. Several surgical procedures are available with variable risk and weight loss outcomes. However, regardless of the procedure performed, surgery is considered a tool that is adjunctive to choosing a healthy, calorie-controlled diet and engaging in daily physical activity. For patients who undergo restrictive-malabsorptive or malabsorptive operations, dietary supplementation is necessary to avoid nutritional deficiencies. Patients are at risk for weight regain following surgery due to several biopsychosocial factors. In order to maximize successful outcomes, all patients should be monitored and managed by a multidisciplinary team of healthcare providers knowledgeable in bariatric surgical care.
Achieving a Healthy Body Weight: Diet and Exercise Interventions for Type 2 Diabetes
Emmanuel Opara in NUTRITION and DIABETES, 2005
As an additional challenge, OB patients who have type 2 diabetes may be more resistant to the maintenance of weight loss because antidiabetic drugs, such as insulin and sulfonylurea, often promote weight gain. The progressive nature of diabetes means that even with successful monotherapy (e.g., management by diet/weight loss) glycemic control may deteriorate over time, necessitating the addition of pharmacologic treatments, including insulin (20), as discussed in the chpater by Lien and Feinglos in Section II of this book. In patients with longstanding disease or pronounced pancreatic β-cell dysfunction, moderate weight loss may not be sufficient to achieve satisfactory glycemic control. There may be a need for more intensive, ongoing intervention, including an escalation of calorie restriction to a very low-calorie diet, e.g., 800 Kcal/day or less (4, 55). In this event, a routine vitamin/mineral supplement and routine nutritional monitoring should be employed, and indications of medical complications, including gallstones (56), should be monitored. Weight-loss-promoting medications may need to be considered in some cases when calorie reduction and exercise do not result in sufficient weight loss, i.e., BMI ≥ 30 or BMI ≥ 27 plus OW/OB-related comorbid conditions. Bariatric surgery may be considered with a BMI ≥ 40 or BMI ≥ 35 plus comorbid conditions (47).
Seasonal variations of changes in lipid and glucidic variables after bariatric surgery
Published in Chronobiology International, 2019
Trinitat Cambras, Eva Pardina, Júlia Carmona, David Ricart-Jané, Antonio Miñarro, Roser Ferrer, Albert Lecube, José María Balibrea, Enric Caubet, Oscar González, Ramón Vilallonga, Jose Manuel Fort, Elena Cuello, Juan A. Baena-Fustegueras, Antoni Díez-Noguera, Julia Peinado-Onsurbe
If seasonal responses are present in human physiology, they should be reflected not only in body weight gain but also in the responses to interventions to body weight loss. Bariatric surgery is a weight loss strategy for severe obesity. Surgical weight loss approaches are based on intestinal malabsorption and gastric reduction. The Roux-en-Y gastric bypass (RYGBP) has become the gold standard of bariatric surgery. RYGBP represents a mixed technique, combining restriction derived from leaving a small stomach pouch near the oesophagogastric junction by excluding the greater curvature together with a small malabsorptive component derived from bypassing most of the stomach and duodenum (Deitel 1998). After surgery, changes in biochemical variables are observed in one to three months after surgery as a consequence of body mass loss (Pardina et al. 2009c). We hypothesized that if seasonal responses are manifested in humans, changes in biochemical variables after surgery would depend on the time of the year that surgery took place and could thus interfere in the diagnoses of the success of the operation.
Physical activity with hindrances: a qualitative study of post bariatric patients’ experiences of physical activity in relation to excess skin
Published in Journal of Plastic Surgery and Hand Surgery, 2022
Monika Fagevik Olsén, Sabina Gren, Sofia Heydeck Sundberg, Christina Biörserud
All participants highlighted the importance of physical activity, both generally and especially after undergoing bariatric surgery. It was described as a prerequisite for feeling well, both physically and mentally, maintaining a desired weight and coping with one’s work. In addition, the participants felt that physical activity could kick-start them, make them more attractive, feel good about themselves and radiate more openness and joy. They described feeling good after being physically active and also a natural fatigue. The bariatric surgery was described as a tool for losing weight, and maintaining the weight loss and returning to, or receiving an active lifestyle, through proper exercise and good nutrition. This was something most participants strived for, to not regain weight.
Endothelial function in obesity and effects of bariatric and metabolic surgery
Published in Expert Review of Cardiovascular Therapy, 2020
Elijah Sanches, Besir Topal, Monika Proczko, Pieter S. Stepaniak, Rich Severin, Shane A. Phillips, Ahmad Sabbahi, Juan Pujol Rafols, Sjaak Pouwels
The treatment of obesity often requires a multidisciplinary approach and well known is the 4-tier framework suggested by Capehorn et al. [17]. The framework tiers ascend in intensity, whereas tier 1 to 2 are conservative and tier 4 concerns surgery. Tier 1 is primary activity, coordinated by the general physician. Tier 2 consists of a tighter regiment of lifestyle changes, preferably in-group setting. Tier 3 is a multidisciplinary approach with obesity specialists (e.g. physiotherapist, nutrionist, psychologist, and an internist). Bariatric surgery is the last treatment option regarding obesity. Bariatric surgery is indicated only for obese patients with a BMI>40 kg/m2 or with a BMI>35 kg/m2 with comorbidities related to the obesity. The effect of these different kinds of bariatric surgery procedures [Sleeve Gastrectomy (SG), Roux-en-Y gastric Bypass (RYGB) or One Anastomosis Gastric Bypass (OAGB)] goes beyond the primary goal of weight loss [1]. These procedures ameliorate the outcomes of several comorbidities like cardiovascular, pulmonary, and metabolic diseases. Also, in several studies, bariatric surgery has a positive effect on the characteristics of adiposopathy [4,5].
Related Knowledge Centers
- Duodenal Switch
- Mortality Rate
- Obesity
- Set Point Theory
- Type 2 Diabetes
- Cardiovascular Disease
- Standard Treatment
- Sleeve Gastrectomy
- Meta-Analysis
- Risk Factor