Bariatric Surgery: Risks and Rewards

East Carolina University, Greenville, North Carolina 27834, USA.
Journal of Clinical Endocrinology & Metabolism (Impact Factor: 6.21). 11/2008; 93(11 Suppl 1):S89-96. DOI: 10.1210/jc.2008-1641
Source: PubMed


Over 23 million Americans are afflicted with severe obesity, i.e. their body mass index (in kilograms per square meter) values exceed 35. Of even greater concern is the association of the adiposity with comorbidities such as diabetes, hypertension, cardiopulmonary failure, asthma, pseudotumor cerebri, infertility, and crippling arthritis.
Diets, exercise, behavioral modification, and drugs are not effective in these individuals. This article examines the effect of surgery on the control of the weight and the comorbidities, as well as the safety of these operations.
Although the article focuses on the outcomes of the three most commonly performed operations, i.e. adjustable gastric banding, the gastric bypass, and the biliopancreatic bypass with duodenal switch, it aims for perspective with the inclusion of abandoned and current investigational procedures, a review of the complications, and an emphasis on the appropriate selection of patients. POSITIONS: Ample evidence, including controlled randomized studies, now document that bariatric surgery produces durable weight loss exceeding 100 lb (46 kg), full and long-term remission of type 2 diabetes in over 80% with salutary effects on the other comorbidities as well with significant reductions in all-cause mortality. Although the severely obese present with serious surgical risks, bariatric surgery is performed safely with a 0.35% 90-d mortality in Centers of Excellence throughout the United States-similar to the complication rates after cholecystectomy.
Until better approaches become available, bariatric surgery is the therapy of choice for patients with severe obesity.

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    • "The surgeries used for treating severe obesity include restrictive surgeries that limit food intake, such as vertical banded gastroplasty (VBG), adjustable gastric band (AGB), and sleeve gastrectomy (SG); and mixed surgeries that combine food intake restriction with nutrient malabsorption, such as Roux-en-Y gastric bypass (RYGB) and biliopancreatic diversion (BPD) with duodenal switch (BPD-DS) (Pories, 2008). "
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    ABSTRACT: Obesity ultimately results from an unbalance between the intake and oxidation of the energy obtained from foods, and its treatments are based on correcting this unbalance by basicallyrestricting energy intake. Consequently, food intake is the center of attention when the subject is obesity, either as an etiological, protection, or even therapeutic factor. The inability of severely obese individuals to reduce or maintain their body weight using traditional methods makes them candidates to bariatric surgery, which is admittedly an effective method to reduce body weight significantly and obesity-associated morbidities. Bariatric surgery involves anatomic and physiological changes in the gastrointestinal tract that promote energy restriction, essential for weight loss, but also the restriction of many essential dietary nutrients. In addition to the anatomic aspects, bariatric surgery decreases appetite and increases postprandial satiety, possibly because of its effect on the secretion of hormones that regulate these systems (Kohli, Stefater e Inge, 2011). In addition to reducing body weight significantly, bariatric surgery also decreases some systemic inflammation markers (Chen et al., 2009; Miller et al., 2011), improves insulin sensitivity, promoting remission of type 2 diabetes (T2D), and lowers high blood pressure, among others. Although bariatric surgery is associated with better quality of life, nutritional deficiencies may occur after surgery because of the dramatically reduced food intake and/or micronutrient absorption. Unmonitored postoperative patients may develop severe malnutrition (Dodell et al., 2012). The literature has often reported deficiencies of vitamin B complex, iron, folic acid, vitamin D, and calcium (Saltzman e Karl, 2013). These deficiencies may cause neurological symptoms, osteopenia, and anemia. Hence, the nutritional approach of the bariatric patient, which began when the patient was in line for surgery and continued after surgery, is one of the most important themes of the interdisciplinary care of obese patients. The objective of this chapter is to review the theoretical bases for the nutritional approach of bariatric patients, the instruments for assessing food intake, and the nutritional recommendations, both preoperatively, when the patient is preparing for surgery, and postoperatively, during follow-up. The chapter also includes practical examples.
    Full-text · Chapter · Oct 2014
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    • "An even more vexing question is whether the benefits of bariatric surgery in patients with type 2 diabetes and BMI 27–35 kg/m2 are sufficient to justify the side effects of the procedures [51, 53]. An operative mortality of 0.2–0.3 "
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    ABSTRACT: Is bariatric surgery as primary therapy for type 2 diabetes mellitus (T2DM) with body mass index (BMI) <35 kg/m2 justified? Open-label studies have shown that bariatric surgery causes remission of diabetes in some patients with BMI <35 kg/m2. All such patients treated had substantial weight loss. Diabetes remission was less likely in patients with lower BMI than those with higher BMI, in patients with longer than shorter duration and in patients with lesser than greater insulin reserve. Relapse of diabetes increases with time after surgery and weight regain. Deficiencies of data are lack of randomized long-term studies comparing risk/benefit of bariatric surgery to contemporary intensive medical therapy. Current data do not justify bariatric surgery as primary therapy for T2DM with BMI <35 kg/m2.
    Full-text · Article · Jun 2013 · Obesity Surgery
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    • "Bariatric surgery is the most effective weight loss treatment, surpassing drug therapies and lifestyle interventions (2). Vertical sleeve gastrectomy (VSG) is a bariatric procedure that involves the removal of ∼80% of the stomach along the greater curvature, creating a gastric “sleeve” in continuity with the esophagus and pylorus. "
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    ABSTRACT: Glucagon-Like Peptide-1 (GLP-1) is a peptide hormone that is released from the gut in response to nutrient ingestion, and has a range of metabolic effects including enhancing insulin secretion and decreasing food intake. Post-prandial GLP-1 secretion is greatly enhanced in rats and humans following some bariatric procedures, including Vertical Sleeve Gastrectomy (VSG), and has been widely hypothesized to contribute to reduced intake, weight loss and the improvements in glucose homeostasis after VSG. We tested this hypothesis using two separate models of GLP-1 receptor deficiency. We found that VSG-operated GLP-1r deficient mice responded similarly to wild-type controls in terms of body weight and body fat loss, improved glucose tolerance, food intake reduction and altered food selection. These data demonstrate that GLP-1 receptor activity is not necessary for the metabolic improvements induced by VSG surgery.
    Full-text · Article · Feb 2013 · Diabetes
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