Who Should Consider Obesity Surgery?
Bariatric surgery is an effective treatment for individuals struggling with obesity and related health conditions. It is recommended for:
- BMI ≥35 kg/m² (body mass index, a measure of weight relative to height), even without additional health conditions.
- BMI 30–34.9 kg/m² with poorly controlled Type 2 diabetes or metabolic syndrome (a group of conditions that increase the risk of heart disease, stroke, and diabetes).
- Asian populations with a BMI ≥27.5–32.5 kg/m², as obesity-related health risks occur at lower BMI thresholds in these groups.
These recommendations are based on the 2022 guidelines from the American Society for Metabolic and Bariatric Surgery (ASMBS) and the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO). These updated criteria reflect the latest understanding of obesity and its complications, expanding access to surgery for those who can benefit most.
When Should Obesity Surgery Be Avoided?
Bariatric surgery may not be suitable in the following situations:
- Active, untreated psychiatric disorders (mental health conditions like severe depression or anxiety that are not being treated).
- Substance abuse issues (current addiction to alcohol or drugs).
- Severe lung or heart disease that makes surgery unsafe (e.g., needing oxygen therapy for breathing).
- Significant endocrine disorders (hormonal problems like untreated Cushing’s Syndrome that can cause weight gain).
- Inability to comply with long-term care, such as:
- Taking vitamin supplements regularly (to avoid deficiencies).
- Attending follow-up appointments (to monitor progress and prevent complications).
- Refusing a preoperative psychological evaluation (an assessment to determine if the person is ready for surgery and the changes it requires).
Surgery is safest and most effective when these risks are addressed beforehand.
Types of Bariatric Surgery
Bariatric surgery includes several procedures, each with distinct benefits and considerations:
Roux-en-Y Gastric Bypass (RYGB)
- Creates a small stomach pouch and bypasses part of the small intestine.
- Highly effective for weight loss, Type 2 diabetes, and GERD.
- Requires vitamin and mineral supplementation due to malabsorption.
Sleeve Gastrectomy
- Removes most of the stomach, leaving a narrow "sleeve."
- Reduces hunger and does not cause malabsorption.
- Simpler with fewer complications than bypass procedures.
One Anastomosis Gastric Bypass (OAGB/MGB)
- Creates a long stomach pouch with one connection to the small intestine.
- Combines restriction and mild malabsorption, effective for diabetes and weight loss.
- Faster surgery but may cause bile reflux in some patients.
SADI-S (Single Anastomosis Duodeno-Ileal Bypass with Sleeve)
- Combines sleeve gastrectomy with intestinal bypass.
- Preserves the pylorus, reducing dumping syndrome and ulcer risk.
- Effective for higher weight loss and diabetes control.
Adjustable Gastric Band
- Places a band around the stomach to restrict food intake.
- Less commonly used due to lower long-term success and higher complication rates.
Each procedure offers unique benefits, and the choice depends on individual health needs and goals. Consultation with a bariatric surgeon is essential to determine the best option.
Obesity Surgery as a Tool
Bariatric surgery is not a quick fix but a comprehensive tool to help manage obesity. To achieve the best results, patients must commit to:
- Following a nutritionally balanced diet (eating healthy foods in the right amounts).
- Engaging in regular physical activity (exercising regularly based on your ability).
- Seeking mental health support (getting help for emotional eating or stress-related habits).
- Attending lifelong follow-up appointments (to monitor your health and prevent complications).
Surgery works best when combined with these other steps, preventing weight regain and supporting long-term success.
Proven Benefits of Obesity Surgery on Comorbidities
Bariatric surgery leads to long-term weight loss and significantly improves many obesity-related health problems, including:
- Type 2 diabetes: Many patients experience remission (their blood sugar levels return to normal without medication).
- High blood pressure: Reduced risk of heart attack and stroke.
- High cholesterol: Improved levels of fats in the blood, lowering heart disease risk.
- Obstructive sleep apnea: Improved sleep and reduced need for breathing devices (like CPAP machines).
- Joint and back pain: Less strain on joints, making movement easier.
- Non-alcoholic fatty liver disease (NAFLD): Improvement in liver health, preventing progression to severe conditions like cirrhosis.
- Polycystic ovarian syndrome (PCOS): Improved fertility and hormone balance.
These benefits improve overall health, reduce dependence on medications, and enhance quality of life.
Additional Expected Improvements
In addition to proven health benefits, bariatric surgery is associated with:
- Lower cancer risk: Reduced chance of developing certain cancers, such as breast, colon, and uterine cancer.
- Better heart health: Lower risk of heart failure and blood clots.
- Safer pregnancies: Fewer complications for both the mother and baby.
- Reduced stroke risk: Fewer cases of cerebrovascular events (like strokes).
Bariatric surgery offers life-changing benefits beyond weight loss, improving health and longevity.
