Photo Credit: Rudzhan Nagiev

The landscape of obesity, and the role bariatric procedures play in its treatment, from how they promote weight loss to the potential risks and complications.

As the number of individuals affected by obesity rises, finding effective solutions has become increasingly urgent. Bariatric procedures can be a transformative option in the treatment of obesity. As the medical community delves deeper into the complexities of this disease, the role of bariatric surgery has garnered attention for its ability to aid in weight loss but also for its potential to address obesity-related comorbidities. This article explores the landscape of obesity, and the role bariatric procedures play in its treatment, from how they promote weight loss to the potential risks and complications.

Promoting Weight Loss

1. Reduced stomach capacity: Most bariatric surgeries work by physically restricting the amount of food the stomach can hold. This leads to earlier satiety, helping people consume fewer calories and lose weight.
2. Hormonal changes: These procedures induce hormonal changes that help reduce appetite, enhance feelings of fullness, and sometimes affect the body’s metabolism. For example, changes in gut hormones such as ghrelin, peptide YY, and glucagon-like peptide-1 (GLP-1) can influence hunger and satiety.
3. Malabsorption: Some procedures, like gastric bypass, also cause a degree of malabsorption, where the body absorbs fewer calories and nutrients from the food passing by the gastrointestinal tract, contributing to weight loss.

Reducing Obesity-Related Health Complications

Bariatric surgery plays a crucial role in reducing the risk for obesity-related health complications through significant and sustained weight loss. It has been shown to improve or resolve conditions such as type 2 diabetes, hypertension, obstructive sleep apnea, metabolic dysfunction associated steatotic liver disease, and dyslipidemia. This improvement is partly due to excess weight loss and hormonal changes, which positively affect insulin sensitivity and cardiovascular risk factors.

Long-Term Results

Bariatric surgery can offer long-term weight loss and maintenance, unlike other weight loss methods that often result in regaining weight. Lifestyle changes, including nutrition and physical activity, along with ongoing medical follow-up, enhance the success of outcomes. Behavioral and psychological support is also crucial to ensure adherence to dietary guidelines and to address eating behaviors.

Substantial evidence supports the long-term success of bariatric procedures in treating obesity. Patients who undergo these surgeries typically experience more significant weight loss compared to those who attempt lifestyle modifications alone, with many maintaining a substantial portion of their weight loss over the long term. Long-term outcomes also include improved quality of life and reduced mortality from diabetes, heart disease, and cancer.

Considerations for Candidacy

Not everyone with obesity is a suitable candidate for bariatric surgery. Factors that may determine suitability include body mass index (BMI), previous attempts at weight loss, comorbid health conditions, psychological readiness, and the inability to commit to lifelong dietary and lifestyle changes.

Potential Risks and Complications

As with any surgery, bariatric procedures have potential risks and complications, both during and after the surgery. These can include, but are not limited to, infection, blood clots, bleeding, nutrient deficiencies, change in bowel habits, and issues related to the surgical alterations of the gastrointestinal tract like dumping syndrome or bowel obstruction. Long-term follow-up with healthcare professionals is essential to monitor and manage these risks.

For healthcare professionals considering whether to include bariatric procedures within a comprehensive obesity treatment plan, assessing the patient’s overall health, obesity-related complications, previous weight loss attempts, and readiness to adhere to post-operative lifestyle changes is crucial. It’s also vital to consider the potential benefits and risks of surgery on a case-by-case basis, which should include:

• Comprehensive evaluation: Assess the patient’s medical history, psychological state, and readiness for lifestyle changes.
• Multidisciplinary approach: Involve dietitians, psychologists, and physical therapists in pre- and post-operative care.
• Education and support: Provide detailed information about the benefits, risks, and lifestyle changes required for success after surgery.

For individuals not qualifying for bariatric procedures, there are several effective options to manage and treat obesity. These include lifestyle modifications, pharmacotherapy, and potentially newer non-surgical procedures:

• Lifestyle modifications: This foundational approach includes diet, physical activity, and behavior changes. Structured programs focusing on reducing calorie intake, increasing physical activity, and implementing behavior changes can lead to significant weight loss and health improvements. Nutritional counseling and support groups can also be beneficial.
• Pharmacotherapy: Several prescription medications are approved for weight management in adults, some of which can result in significant weight loss when used with lifestyle modifications. These medications work through various mechanisms, such as reducing appetite or increasing feelings of fullness. Examples include orlistat, phentermine-topiramate, naltrexone-bupropion, liraglutide, semaglutide, and tirzepatide. It’s important to discuss the potential benefits, side effects, and contraindications of these medications with a healthcare professional.
• Non-Surgical procedures: Several newer non-surgical interventions have shown promise for weight loss. These include:
• Intragastric balloons: A balloon is temporarily placed in the stomach to reduce space available for food, thereby promoting satiety and reducing food intake.
• Endoscopic sleeve gastroplasty: A procedure that reduces stomach size using sutures placed through an endoscope, mimicking the effect of a surgical sleeve gastrectomy but without the need for incisions.
• Vagal nerve blockade: A device that intermittently blocks nerve activity between the brain and the stomach, reducing hunger and promoting satiety.

The Obesity Medicine Association (OMA) offers several resources for healthcare professionals looking to learn more about bariatric procedures for the treatment of obesity:

• OMA Webinars and Continuing Education: Provides ongoing education on obesity treatment, including bariatric surgery.
• OMA Obesity Algorithm®: A practical, step-by-step guide to diagnosing and treating obesity, including considerations for when to recommend bariatric surgery.