Obesity and inactivity are responsible for 365,000 deaths per year in the US.
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The incidence of severe obesity is increasing at a rapid rate, and this has resulted in a drastic increase in bariatric operations worldwide. Successful obesity surgery has been shown in large-scale prospective trials to result in improved quality of life and a decreased risk of death for people with morbid obesity.
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In addition, bariatric surgery (also referred to as metabolic surgery) is being investigated as a possible primary therapy for type 2 diabetes. Results from randomized controlled trials and systematic reviews with meta-analyses have shown superior glycemic control with bariatric surgery compared with conventional medical therapy alone in people with obesity and type 2 diabetes.
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Buchwald H, Estok R, Fahrbach K, et al. Weight and type 2 diabetes after bariatric surgery: systematic review and meta-analysis. Am J Med. 2009;122:248-256.e5.
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Schauer PR, Bhatt DL, Kirwan JP, et al. Bariatric surgery versus intensive medical therapy for diabetes - 5-year outcomes. N Engl J Med. 2017;376:641-51.
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Müller-Stich BP, Senft JD, Warschkow R, et al. Surgical versus medical treatment of type 2 diabetes mellitus in nonseverely obese patients: a systematic review and meta-analysis. Ann Surg. 2015;261:421-429.
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Mingrone G, Panunzi S, De Gaetano A, et al. Bariatric-metabolic surgery versus conventional medical treatment in obese patients with type 2 diabetes: 5 year follow-up of an open-label, single-centre, randomised controlled trial. Lancet. 2015;386:964-973.
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Furthermore, guidelines from national and international organizations, such as the American Diabetes Association,
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the UK-based National Institute for Health and Care Excellence,
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and the International Diabetes Foundation,
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International Diabetes Federation. Bariatric surgical and procedural interventions in the treatment of obese patients with type 2 diabetes. A position statement from the International Diabetes Federation Taskforce on Epidemiology and Prevention. 2011. http://www.idf.org (last accessed 16 February 2017).
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Dixon JB, Zimmet P, Alberti KG, et al; International Diabetes Federation Taskforce on Epidemiology and Prevention. Bariatric surgery: an IDF statement for obese Type 2 diabetes. Diabet Med. 2011;28:628-642.
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recommend the use of bariatric surgery in people with obesity and type 2 diabetes who have inadequate glycemic control on optimal medical therapy alone.
The mechanism of action of bariatric surgery for obesity is not fully understood at present but is felt to include gastric volume restriction, malabsorption, and hormonal changes.
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Beckman LM, Beckman TR, Earthman CP. Changes in gastrointestinal hormones and leptin after Roux-en-Y gastric bypass procedure: a review. J Am Diet Assoc. 2010;110:571-584.
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After bariatric surgery, patients may present to clinics, emergency departments, or a hospital other than the one where they had the operation. Thus, it is necessary to be knowledgeable about the common complications.
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Clinical Issues Committee of the American Society for Metabolic and Bariatric Surgery. American Society for Metabolic and Bariatric Surgery position statement on emergency care of patients with complications related to bariatric surgery. Surg Obes Relat Dis. 2010;6:115-117.
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http://www.ncbi.nlm.nih.gov/pubmed/20189469?tool=bestpractice.com
The obese abdomen may be difficult to examine and can mask typical signs of sepsis. Careful attention to vital signs, examination findings, and any deviation from expected postoperative course is essential.
In order to help patients sustain weight loss after bariatric surgery, regular self-monitoring and frequent postoperative follow-up visits may be required.
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Odom J, Zalesin KC, Washington TL, et al. Behavioral predictors of weight regain after bariatric surgery. Obes Surg. 2010;20:349-356.
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