Weight Loss Surgery
Bariatrics is the branch of medicine that
deals with the causes, prevention, and treatment of obesity. The
term bariatrics was created around 1965, from the Greek root baro
("weight," as in barometer) and suffix -iatrics ("a branch of
medicine," as in pediatrics). Besides the pharmacotherapy of
obesity, it is concerned with obesity surgery.
Overweight and obesity are rising medical problems of pandemic
proportions. There are many detrimental health effects of obesity:
heart disease, diabetes, many types of cancer, asthma, obstructive
sleep apnea, chronic musculoskeletal problems, etc. There is also a
clear effect of obesity on mortality, though this is not so clear
for overweight.
For complete details of the
weight loss surgery or procedure in which you have an interest, here's
where you can get your personal
price quote.
Diagnosis
Although not a direct measure of body fat, the
Body Mass Index is widely adopted and promoted as a marker for
excess body weight. However, it is not flawless: a very muscular
person may be assessed as obese, and an elderly person with low body
weight but high body fat (this can happen due to low muscle mass and
bone density) may be assessed as healthy. Other markers for the
evaluation of obesity include waist circumference (associated with
central obesity), and a patient's risk factors for diseases and
conditions associated with obesity. Besides these indirect methods,
body fat can also be measured directly.
General aspects of the treatment
Although diet, exercise, behavior therapy
and anti-obesity drugs are first-line treatment, medical therapy for
severe obesity has limited short-term success and almost nonexistent
long-term success. Therefore, obesity surgery (or bariatric surgery)
has been a popular treatment in the war against obesity. Weight loss
surgery generally results in greater weight loss than conventional
treatment, and leads to improvements in quality of life and obesity
related diseases such as hypertension and diabetes.
Before someone can become eligible for bariatric surgery, certain
criteria must be met.[9] The basic criteria are an understanding of
the operation and the lifestyle changes the patient will need to
make, and either:
* a body mass index (BMI) of 40 or more, which is about 45 kg (100
pounds) overweight for men and 35 kg (80 pounds) for women; or
* a BMI between 35 and 39.9 and a serious obesity-related health
problem such as type 2 diabetes, heart disease, or severe sleep
apnea (when breathing stops for short periods during sleep)
Past studies found that 10 percent to 20 percent of bariatric
surgery patients had complications while they were in the hospital.
In 2006, federal researchers found that 39.6 percent of patients had
complications within 180 days of surgery. The most common
complications are:
A composite of gastrointestinal symptoms including vomiting,
diarrhea, dysphagia, and reflux (20%)
Anastomotic leaking (at the surgical connections between the stomach
and the intestine) (12%)
Abdominal hernia (7%)
Infections (6%).
About 7% of patients were readmitted to the hospital within 6 months
to treat complications specific to the bariatric procedure.
There were 212 in-hospital deaths out of an estimated 104,702 adults
who underwent obesity surgery in 2003, or a rate of 0.2 per cent.
The prevalence of extreme obesity (body mass index > or = 40 kg/m²)
in the United States in 2003-2004 was 2.8% in men and 6.9% in women.
This suggests millions of people are in the weight range for
potential therapy with bariatric surgery. Laparoscopic surgery has
become an important addition to this field of surgery, and demand
soars, amidst scientific and ethical questions. The number of
Americans having weight-loss surgery more than quadrupled between
1998 and 2002—from 13,386 to 71,733—according to a study by the
Agency for Healthcare Research and Quality.
Surgical Procedures
There are a number of surgical options
available to treat obesity, each with their advantages and pitfalls.
In general, weight reduction can be accomplished, but one must
consider operative risk (including mortality) and side effects.
Usually, these procedures can be carried out safely. Procedures can
be grouped in three main categories (although this is somewhat
artificial):
Predominantly malabsorptive procedures: although also reducing
stomach size, these operations are based mainly on malabsorption.
Biliopancreatic Diversion (Scopinaro procedure - rare) predominantly
restrictive procedures: this kind of surgery primarily reduces
stomach size
Vertical Banded Gastroplasty (Mason procedure, stomach stapling)
Adjustable gastric band (or "Lap Band")
Sleeve gastrectomy
Mixed procedures: applying both techniques simultaneously; gastric
bypass surgery, like Roux-en-Y gastric bypass, Sleeve gastrectomy
with Duodenal Switch
For complete details of the
weight loss surgery or procedure in which you have an interest, here's
where you can get your personal
price quote.
