Bariatric Surgery1



Bariatric Surgery1


Kevin Tymitz

Thomas Magnuson

Michael Schweitzer





Obesity is a significant health concern in this country. It is a disease that is created by a multitude of genetic and environmental factors. The consequences of obesity are as equally complex as its etiology, affecting every organ system in the human body as well as imposing serious psychological stress often associated with social isolation, depression, and numerous other psychologic comorbidities. Medical management, unfortunately, usually fails to achieve sustained weight loss; and currently, bariatric surgical procedures are the most effective means to achieve sustained weight loss and also provide durable treatment of obesity-associated morbidities.

Weight-loss surgery is not a simple “cure” for this very complex and debilitating disease. It does, however, provide a powerful tool for patients to achieve success. A successful long-term outcome depends on the patient’s commitment to a lifetime of dietary and lifestyle changes. For this reason, there must be a multidisciplinary approach that includes surgeons, primary care physicians, psychologists, nurses, and dietitians to provide critical instructions to help patients adhere to the dietary and lifestyle changes consistent with the surgery.

The several types of bariatric surgery differ in expected outcomes in terms of weight loss and the likelihood of predisposing patients to nutritional deficiencies postoperatively. To understand these deficiencies and their appropriate management fully, it is imperative to understand the origin of the deficit. The purpose of this chapter is to review the various surgical procedures currently offered and the potential nutritional deficiencies that may ensue. Health care professionals must be aware of these deficiencies and the practice guidelines that must be followed to prevent these deficiencies because some of them may have serious consequences.


OVERVIEW

The prevalence of obesity continues to increase at an alarming rate throughout industrialized nations. Obesity is a disease that affects 34% of adults 20 years old and older in the United States, and this amounts to more than 72 million people. Approximately 33.3% of US men and about 35.3% of US women are obese. Nearly 6% of adults are classified as morbidly obese, with a body mass index (BMI) greater than 40 (1).

Obesity is a leading preventable cause of death worldwide, with increasing prevalence in adults and children. It is viewed as one of the most serious public health problems of the twenty-first century. Obesity is stigmatized in much of the modern world (particularly in the Western world), although it was widely perceived as a symbol of wealth and fertility at other times in history and still is in some parts of the world.

Health care professionals need to be concerned about the prevalence of obesity because of the well-established relationships between excess body weight and serious medical conditions such as type 2 diabetes, hypertension, and heart disease, just to name a few. These relationships have long been established in the adult obese population and more recently also have been observed at an increasing rate in the adolescent population.

Unfortunately, no single solution to prevent or treat obesity is beneficial for everyone. Treatment of obesity
may include a combination of diet, exercise, behavior modification, and medications. For most patients, although these methods may provide a moderate amount of weight loss, the benefits are usually short lived. Hence, bariatric surgery has evolved over the past couple of decades and has been shown to be effective in reducing obesity-related comorbidities, improving the quality of life, and decreasing the number of sick days, monthly medication costs, and overall mortality. With the increasing rates of weight loss procedures, the quality, efficacy, and surgical outcomes have improved with the creation of Bariatric Centers of Excellence designated by the American Society of Metabolic and Bariatric Surgery and the American College of Surgeons. The benefits of bariatric procedures in morbidly obese patients outweigh the risks. With the advent of minimally invasive surgical procedures, bariatric surgery is a reasonable treatment option in those who strongly desire substantial weight loss and have life-threatening comorbid conditions.


Definition of Morbid Obesity

The definition and classification of obesity are based on calculation of the BMI—calculated as weight in kilograms divided by height in meters squared. For the majority of the population (except athletes), BMI provides a reliable indicator of the body fat composition. It is used to stratify patients into categories that may lead to health problems. Patients with a BMI of 30 to 35 kg/m2 are considered to have class I obesity, a BMI of 35 to 40 kg/m2 is class II, and a BMI higher than 40 kg/m2 is class III. Morbid obesity is defined as a BMI of 40 kg/m2 or higher or a BMI of 35 kg/m2 or higher in patients with comorbidities. Patients are defined as suffering from superobesity or megaobesity if their BMI is higher than 50 or 70 kg/m2, respectively.



Jul 27, 2016 | Posted by in PUBLIC HEALTH AND EPIDEMIOLOGY | Comments Off on Bariatric Surgery1

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