What Is Bariatric Surgery?

Bariatric surgery describes a set of surgeries used to treat morbid obesity.¹ These surgeries alter the digestion and absorption of food by either removing a portion of the stomach or rerouting the gastrointestinal tract.² The most common procedures are laparoscopic sleeve gastrectomy and laparoscopic Roux-en-Y gastric bypass surgeries. Laparoscopic sleeve gastrectomy removes a large portion of the stomach, thereby reducing the amount of food one can consume.^3,4 Laparoscopic Roux-en-Y gastric bypass surgery cuts off a portion of the stomach and reattaches it to the small intestine, allowing food to bypass most of the stomach and the upper portion of the small intestine and thereby reduce the absorption of nutrients.^4,5 These surgeries, though effective, are only recommended when non-surgical interventions such as diet, physical activity, behavioral interventions, and medications have been unsuccessful.

Who Is it for?

Bariatric surgery can be helpful for those struggling with weight loss and obesity but is not for everyone.¹ Bariatric surgery can be suggested to individuals who meet the following criteria:

• Body mass index (BMI) of >40 kg/m² without comorbidities or
• BMI >35 kg/m² with one or more comorbidities (eg, metabolic syndrome, diabetes, hypertension) and
• Documented unsuccessful attempts at weight loss through lifestyle changes

Bariatric surgery is not for individuals with the following characteristics:⁶

• BMI <35 kg/m²
• Age <18 years or >65 years
• Medical conditions that carry high risk of complication with surgery
• Lack of attempt to optimize lifestyle or medical treatments
• History of poor compliance to medical and lifestyle interventions
• Unrealistic expectations of surgical treatment or of postsurgical weight
• Clinically unstable mental health conditions
• Pregnant or lactating, or plans to within 2 years of surgery
• Current smokers

Does It Help With Weight Loss?

Bariatric surgery has been documented to help with achieving significant weight loss in individuals with morbid obesity.¹ Research shows that at 20 years after bariatric surgery, total weight loss % was at 22.2% and percentage of excess weight loss was 48.9%. Studies also show that in obese individuals with type 2 diabetes mellitus, bariatric surgery leads to more significant weight loss than non-surgical options. Additionally, bariatric surgery has shown to help normalize blood glucose levels, improve blood lipid levels, lower blood pressure, and lower risk of diabetes-related macro- and microvascular complications. However, it should be noted that a small group of individuals may experience significant weight regain after bariatric surgery. It is critical to continue following lifestyle, behavioral, and medication guidance given by health care professionals even after a successful surgery. 

References

1. Gulinac M, Miteva DG, Peshevska-Sekulovska M, et al. Long-Term Effectiveness, Outcomes and Complications of Bariatric Surgery. World J Clin Cases. 2023;11(19):4504-4512. doi:10.12998/wjcc.v11.i19.4504
2. Stahl JM, Malhotra S. Obesity Surgery Indications and Contraindications. In: StatPearls. StatPearls Publishing; 2024. Accessed April 9, 2024. http://www.ncbi.nlm.nih.gov/books/NBK513285/
3. Seeras K, Sankararaman S, Lopez PP. Sleeve Gastrectomy. In: StatPearls. StatPearls Publishing; 2024. Accessed April 11, 2024. http://www.ncbi.nlm.nih.gov/books/NBK519035/
4. Wolfe BM, Kvach E, Eckel RH. Treatment of Obesity: Weight Loss and Bariatric Surgery. Circ Res. 2016;118(11):1844-1855. doi:10.1161/CIRCRESAHA.116.307591
5. Mitchell BG, Gupta N. Roux-en-Y Gastric Bypass. In: StatPearls. StatPearls Publishing; 2024. Accessed April 11, 2024. http://www.ncbi.nlm.nih.gov/books/NBK553157/
6. Karmali S, Stoklossa CJ, Sharma A, et al. Bariatric Surgery. Can Fam Physician. 2010;56(9):873-879.