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Treatment of Obesity: Weight Loss and Bariatric Surgery

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Bariatric surgery includes a type of procedure that is performed on people with obesity. Weight loss is achieved by reducing the size of the stomach with a gastric band, or by removing part of the stomach (sleeve gastrectomy or biliopancreatic diversion with duodenal switch), or by resection and rerouting the small intestine into a small stomach pouch (see Gastric Bypass Surgery).

The fundamental basis for bariatric surgery for the purpose of weight loss is the recognition that severe obesity is a disease associated with multiple adverse health effects that are reversed or ameliorated by successful weight loss in patients who have not been able to sustain weight loss can be non-surgical means. It even helps reduce cardiovascular disease (CVD) as well as other anticipated benefits of this intervention. The ultimate benefits of weight reduction relate to reductions in comorbidities, quality of life, and all-cause mortality.

Specific criteria established by the NIH Consensus Panel demonstrated that bariatric surgery is appropriate for all patients with a BMI (kg/m2) > 40 and for patients with a BMI of 35-40 with associated comorbid conditions. These standards have stood the test of time over the years, although specific indications for bariatric/metabolic surgical procedures have been recognized for people with less severe obesity, such as: B. Individuals with a BMI of 30-35 with type 2 diabetes. Indications for bariatric surgery are rapidly evolving to reflect the presence or absence of comorbidities as well as the severity of obesity as reflected in BMI.

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Specific bariatric surgical procedures are Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy, biliopancreatic diversion with duodenal switch, implantation of devices (including adjustable gastric band, intermittent vagal blockade, gastrointestinal endoscopic devices).

Bariatric surgery has made a number of changes to lead to this improved safety record. This includes identifying the importance of surgeon and center experience, establishing treatment pathways, protocols of care, and quality initiatives, and incorporating all of these aspects of care into a center accreditation program. The transition to laparoscopic methodology took place during the same period and also contributed to improved safety.

Weight loss after bariatric surgery has been studied and reported both in the short and long term after all surgical procedures performed, since weight loss is the primary goal of bariatric surgery. The average weight loss is given as a unit. However, it is crucial to recognize the high variability in weight loss following seemingly standardized surgical procedures such as RYGB or Laparoscopic Adjustable Gastric Banding (LAGB).

The ultimate benefit of weight reduction, whether medical or surgical, relates to reductions in comorbidities, quality of life, and all-cause mortality. Despite the importance of assessing these risks and taking steps to implement effective medical management with variable success, surgery has proven to be more effective.

Thanks to Saket Kumar

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