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Bariatric surgery has evolved over time
Options are varied and more affordable
Obesity is a growing problem in the United States and Americans have increasingly turned to surgery to help them lose weight. Nearly 200,000 people now get bariatric surgery each year. The procedures have improved and evolved over the last decade. Dr. Gustavo E. Bello, a bariatric surgeon for the GBMC Comprehensive Obesity Management Program, discusses the latest in bariatric surgery.
The field of metabolic and bariatric surgery has evolved significantly and continues to do so. Basic science and clinical research, along with new technology, have made weight loss surgery not only a safer strategy to fight obesity, but one that is overwhelmingly better and more efficient than any other. The field continues to expand globally and surgeons now have the ability to complete a much more thorough and specialized training process.
Laparoscopic sleeve gastrectomy and gastric bypass are the most commonly performed weight loss surgeries across the board. Together, they account for more than 90 percent of all bariatric surgical procedures. Laparoscopic sleeve gastrectomy, which sits comfortably in first place, has been around for nearly 14 years. It is a procedure that alters the capacity of the stomach by actually removing around 75 percent of its reservoir and leaving the rest of the anatomy intact. The Roux-en-Y gastric bypass, the second most popular, has been performed for more than 40 years now. It helps patients lose weight and get healthier by reducing the capacity of the stomach, by rearranging the intestinal transit that interferes with the different mechanisms involved with how food gets digested and absorbed and by altering and improving patient’s metabolisms.
No doubt weight loss surgery is now covered widely by virtually every insurance with very few rare and disappointing exceptions. This has given almost every patient affected by obesity access to this great tool and treatment modality. The better understanding of the obesity epidemic and its detrimental effects on overall health have increased awareness and made us more proactive on addressing and treating it.
For many years now, the overwhelming majority of insurance companies, including Medicare and Medicaid, have provided coverage for weight loss surgery to those patients with a Body Mass Index (BMI) of 35 Kg/m2 or higher and who can demonstrate that they suffer from an obesity-related medical problem, such as hypertension, diabetes, sleep apnea, liver disease, among others. This is often waived if the patient’s BMI exceeds 40 Kg/m2.
Fortunately, bariatric surgery has become extraordinarily safe with extremely low mortality rates that are now comparable to much more commonly performed operations such as gallbladder removal and hip replacement. Of course it is not completely free of possible complications, including bleeding, infection and the exceedingly uncommon, but troublesome, leakage.
It has been said that long-term success following weight loss surgery occurs in more than 85 percent of cases. Success on definitively eliminating obesity relies first on being well-prepared ahead of time by better understanding the impact that nutrition has in our overall health and being mentally ready to adopt new lifestyle changes. This allows patients to more easily adhere to any post-surgery guidelines and key principles that are necessary to achieve adequate and sustainable weight loss. This begins with following a postoperative diet for a few weeks to allow stomach healing, to then monitoring protein intake as well as proper hydration, compliance with vitamin intake and the increase of physical activity, among other lifestyle and behavioral changes.
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