Is bariatric surgery safe for patients with severe obesity?
May 27, 2016 · In contrast, the Swedish Obese Subjects (SOS) study reported weight loss following a variety of bariatric surgical procedures to be 17% 5 years following surgery, 16% in 15 years, and 18% in 20 years post-surgery 117. Weight was essentially unchanged in the usual care group matched for multiple clinical parameters.
How does bariatric surgery treat teens with severe obesity?
Results: The best candidates for post-bariatric plastic surgery are those who have achieved weight loss stability with a BMI of 35 or less and who have adequate nutrition to heal the surgical excisions. Truncal deformity is the most common presenting complaint of massive weight loss patients, and the procedure of choice to address this region is a lower body lift.
Who is a good candidate for bariatric surgery?
Nov 10, 2018 · The best candidates for surgery are those that want to use surgery as a very effective tool to help them manage their disease of obesity. If you are under age 18 or older than age 65 Dr. Patients who are good candidates for obesity surgery must undergo a screening process in addition to other pre-surgery preparations.
What are the treatment options for clinically severe obesity?
Jan 19, 2016 · Obesity is one of the most prevalent pathogens in the developed world, causing numerous common and lethal diseases. Non-surgical treatments to date have failed to provide an effective, durable solution. Bariatric surgery includes the procedures of gastric bypass, sleeve gastrectomy, gastric banding and biliopancreatic bypass. These procedures have been shown …
What are the factors that determine weight loss?
These factors include but are not limited to the presence of specific comorbid conditions such as diabetes, gender, age and behavioral variables, including physical activity and eating behaviors10.
What is obesity related comorbidity?
Obesity-related comorbidity is defined as conditions either directly caused by overweight/obesity or known to contribute to the presence or severity of the condition. These comorbid conditions are expected to improve or go into remission in the presence of effective and sustained weight loss.
What is Roux en Y gastrojejunostomy?
A Roux-en-Y gastrojejunostomy is done, thus diverting ingested nutrients from the body of the stomach, duodenum, and proximal jejunum. The vagal trunks are not disturbed but a variable number of branches to the body of the stomach are divided in the process of dividing the stomach.
Does bile acid affect gut function?
Bile acid metabolism clearly changes post-metabolic surgery and mechanisms to implicate these alterations to benefit include their beneficial effects on satiety, gut hormones, incretins, energy metabolism and the gut microbiome, with the majority of these effects mediated via the bile acid receptors FXR and TGR5111.
Does bariatric surgery affect the microbiome?
Finally, the gut microbiome is modified following metabolic surgery and this change seems to play an important role in the metabolic benefits gained from bariatric surgery. Two types of surgeries, RYGB and VBG, result in similar changes in the microbiome, an effect that can be maintained for at least a decade.
Surgical treatment of obesity and BMI
One of the most important parameters that need to be taken into consideration while qualifying patients for surgical treatment of obesity is the BMI (body mass index, which is the ratio of a persons’ mass to their height). According to the WHO (World Health Organisation), when somebody’s BMI is greater than or equal to 30 kg/m2, they are obese.
Medical indications for surgical treatment of obesity
A patient with a BMI below 35 whose obesity is associated with other diseases may be a candidate for bariatric surgery. Comorbidities combined with excess body mass often pose a threat to a person’s life.
Psychological disorders and other causes of obesity
Apart from an unhealthy diet, physical inactivity, consumption of high-calorie and heavily processed foods, and metabolic and hormonal problems, obesity may also entail psychological issues. The latter may have an impact on the eating habits of the person suffering from obesity.
What are the two types of surgery for obesity?
Surgery for clinically severe obesity (bariatric surgery) falls into two categories: gastric restrictive procedures and malabsorptive procedures.
What is clinically severe obesity?
Clinically severe obesity is a result of persistent and uncontrollable weight gain that constitutes a present or potential threat to life. There are a variety of surgical procedures and other treatment modalities intended for the treatment of clinically severe obesity. Note: For additional information, please see:
What is operator dependence in bariatric surgery?
Evidence from a number of reports and case series exists for “operator dependence” in determining the risks and benefits of any bariatric procedure. It is important that the surgeon be extensively trained in the respective procedure and that the initial surgeries are supervised by an experienced bariatric surgeon during the early “learning curve.” It is also important that these surgeries be performed in facilities that are appropriately qualified to support peri-operative and post-op services by an appropriately trained, multi-disciplinary team to ensure maximal success.
What is GERD in the esophagus?
GERD is defined as “symptoms or complications resulting from the reflux of gastric contents into the esophagus or beyond, into the oral cavity (including larynx) or lung” (Flores, 2019). Increased BMI, waist circumference and weight gain are associated with the presence of GERD (Katz, 2013; Flores, 2019). New-onset GERD, or the exacerbation of GERD is common following bariatric surgery, affecting up to 33% of individuals (Brethauer, 2014). The typical symptoms of GERD include dyspepsia, epigastric pain, early satiety, belching, and bloating (Katz, 2013). As noted by Brethauer (2014) “treatment of GERD is initially medical with acid suppression but if symptoms are refractory to medical therapy or if there is an associated anatomic etiology for the GERD, surgical revision may be required”. The American College of Gastroenterology’s (ACG) 2013 guideline on GERD notes that a presumptive diagnosis of GERD can be made based on a clinical history of heartburn and regurgitation and can be empirically treated with empiric proton pump inhibitors (PPIs). The ACG guideline also notes “The diagnosis of GERD is made using some combination of symptom presentation, objective testing with endoscopy, ambulatory reflux monitoring, and response to antisecretory therapy”. The ACG includes several recommendations regarding objective testing to confirm the diagnosis of GERD:
What is the definition of obesity?
Obesity: The state of being well above one’s normal weight, which is measured and determined by the Body Mass Index (BMI). Severe obesity is defined by the National Institutes of Health (NIH) as a BMI of 40 kg/m 2 or greater, or a BMI of 35 kg/m 2 or greater along with other medical complications.
Is bariatric surgery considered medically necessary?
Initial and reoperative bariatric procedures are considered not medically necessary when the criteria listed above are not met. Bariatric surgical procedures including, but not limited to, laparoscopic adjustable gastric banding are considered not medically necessary for individuals with a BMI below 35 kg/m².
Is bariatric surgery safe for T2DM?
Bariatric surgery has been investigated as a treatment for type 2 diabetes mellitus (T2DM). To date, studies reporting the results of bariatric surgery on T2DM have primarily included individuals with morbid obesity (that is, with a BMI greater than or equal to 40 or 35-39.9 kg/m 2 with a clinically significant obesity-related comorbidity). There have been very few studies that investigated the safety and efficacy of bariatric surgery, also referred to as metabolic surgery, in individuals with a BMI less than 35 kg/m 2. In 2012, Mingrone published results of a single-center, nonblinded, RCT of 60 subjects between the ages of 30 and 60 years with a BMI of 35 or more and a history of at least 5 years of diabetes. Study participants were randomly assigned to receive conventional medical therapy or bariatric surgery (either GB or BPD). The primary endpoint was the rate of diabetes remission at 2 years (defined as a fasting glucose level of < 100 mg per deciliter [5.6 mmol per liter] and a glycated hemoglobin level of < 6.5% in the absence of pharmacologic therapy). At 2 years, diabetes remission had occurred in no subjects in the medical-therapy group versus 75% in the GB group and 95% in the BPD group (p<0.001 for both comparisons). Age, sex, baseline BMI, duration of diabetes, and weight changes were not significant predictors of diabetes remission at 2 years or of improvement in glycemia at 1 and 3 months. At 2 years, the average baseline HbA1c level (8.65 ± 1.45%) had decreased in all groups, but subjects in the 2 surgical groups had the greatest degree of improvement (average HbA1c levels, 7.69 ± 0.57% in the medical-therapy group, 6.35 ± 1.42% in the GB group, and 4.95 ± 0.49% in the BPD group). The authors concluded that, in severely obese subjects with T2DM, bariatric surgery resulted in better glucose control than did medical therapy and that preoperative BMI and weight loss did not predict the improvement in hyperglycemia seen after surgery (Mingrone, 2012).
What is the body mass index of a 55 year old woman?
The patient: A 55-year-old woman presenting with body mass index of 45kg/m2 and three comorbid conditions—type 2 diabetes mellitus; obstructive sleep apnea; and hypertension; employed as a nurse; has no mental health history, and no current eating-disordered behaviors
What is rygb bypass?
RYGB involves rerouting or creating a shortcut in your intestines so that most of your stomach and part of your small intestine is bypassed. The part of the small intestine that is bypassed is where the immunosuppressant medications you take after transplant to keep your new organ healthy are absorbed.
Is bariatric surgery a volitional control?
If patients maintain the belief that body weight is completely under volitional control and modifiable through diet and exercise alone, they might be less likely to accept that a greater level of risk (i.e., bariatric surgery) will be necessary to achieve the desired improvements in health, mobility, and quality of life.
Does RYGB help with weight loss?
The RYG B might be less effective in terms of weight loss and diabetes remission. But, there are other risks and benefits to consider with DS.