Considerations toward bariatric surgery to address obesity

April 26, 2013 By David H. Okolica, M.D.

Obesity and weight-related medical issues are a tremendous problem in the United States, with two-thirds of the adult population overweight and one-quarter of the adult population obese.

There are many health issues that can arise due to obesity and that can resolve once obesity has been successfully addressed. One weight loss option may be bariatric surgery. Typically, a patient can lose 50-75 percent of excess body weight within one to three years of surgery, depending on the procedure and how well the patient complies with lifestyle changes after surgery.

Bariatric surgery is appropriate if one is more than 80-100 pounds over ideal body weight and if other long-term attempts at weight loss haven't worked.

The ideal surgery candidate. A good potential bariatric patient is someone who is compliant with medical recommendations, has good social support and wants to change his/her lifestyle, even before surgery. Also, patients must be willing to make long-term lifestyle changes to maintain a lower weight. This includes a special diet, daily exercise, and appropriate medical follow-up. Bariatric surgery patients who are younger, mobile, can exercise, and do not smoke are better candidates for surgery.

Types of bariatric surgery. There are three primary bariatric surgery procedures which are commonly performed: gastric bypass, sleeve gastrectomy, and the adjustable gastric band. These are laparoscopic (small incision) procedures that make the stomach size smaller, limiting the amount of food that can be ingested and resulting in weight loss. These procedures have a low overall complication rate, and involve a one- to two-day hospital stay. Gastric bypass causes weight loss by decreasing the amount of food the intestine absorbs; sleeve gastrectomy achieves weight loss through a hormonal effect. With the adjustable gastric band, the size of the stomach pouch can be decreased, which increases the feeling of satiety.

Other health benefits from bariatric surgery. Bariatric surgery inherently changes the body's metabolism and improves health. There is a clear benefit from bariatric surgery on chronic medical conditions such as type 2 diabetes, high blood pressure, high cholesterol, heart disease, heartburn, sleep apnea (trouble breathing while asleep), and joint pain. This constellation of weight-associated medical conditions is referred to as metabolic syndrome, and in the majority of cases bariatric surgery can induce complete remission of metabolic syndrome.

Obesity is a life-long, chronic disease, and bariatric surgery can serve as a tool to assist patients' desire to achieve significant sustained weight loss, and improve their medical status and quality of life.

Dr. David Okolica is medical director of Bariatric Surgery at The Hospital of Central Connecticut Center for Metabolic Health. For referrals to HOCC physicians, please contact our free Need-A-Physician referral service by phone at 800.321.6244.