Since 1996, the national rates of bariatric surgery have increased markedly among adults. This trend may reflect the limitations of behavioral and medical preventive interventions.
For example, the majority of patients initially seek to lose weight through lifestyle changes. Patients who follow an optimal program that uses diet, exercise and behavior modification can expect to achieve and maintain a modest weight loss (10%). However, for morbidly obese patients, these first-line interventions are usually ineffective. In addition, many patients who lose weight regain it later. No published studies have demonstrated significant and sustained weight loss in morbidly obese patients through diet therapy, exercise, or behavior modification.
The goals of obesity surgery are to improve health and quality of life, as well as to increase lifespan. A meta-analysis study in 2005 found that surgery is more effective than non-surgical treatment for weight loss and control of some comorbid conditions in patients with a BMI of 40 kg/m
2 or greater.
Traditional bariatric surgery consists of 2 types: 1) restrictive and 2) malabsorptive; some procedures are a combination of both. Each approach has its own operative procedures and risks of side effects and/or complications. Some operations can now be done laparoscopically rather than using an open surgical approach.
Restrictive surgery uses bands or staples to restrict food intake and promote a feeling of fullness (satiety) after eating. Some of these procedures include:
- Laparoscopic Adjustable Gastric Banding
- Vertical Banded Gastroplasty
- Sleeve Gastrectomy
Malabsorptive procedures, such as bilopancreatic diversion, shorten the digestive tract and reduce the absorption of calories along with proteins and other nutrients.
Combined procedures shorten the digestive tract and reduce how much food the stomach can hold.
- Roux-en-Y Gastric Bypass
- Biliopancreatic Diversion with Duodenal Switch
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