What is Bariatric Surgery?
What is Bariatric Surgery?
Bariatric surgery is a broad field including a number of different procedures which share the common goal of assisting morbidly obese patients in achieving and maintaining weight loss. The specific operation will dictate the nature of the particular benefits and associated risks for the individual patient.
Bariatric surgery is not a cosmetic procedure. It is to assist patients in managing their state of excess body fat. The easiest initial step to assess whether or not a patient may be a candidate for bariatric surgery is to calculate their body mass index (commonly referred to as BMI). The BMI categorizes an individual’s weight in relation to their height with a mathematical formula: BMI= Weight (Kilograms) divided by Height (meters)2. A “normal” BMI may range between 18-25. “Overweight” is indicated with a BMI of 25-29.9. “Obese” is defined by a BMI of 30-34.9. Individuals with a BMI of greater than 35 or 40 are considered “severely obese” and “morbidly obese” respectively.
These latter degrees of obesity carry with them significant health concerns. Diabetes, hypertension, asthma, sleep apnea, hypercholesterolemia, degenerative joint disease, gastroesophageal reflux (heart-burn), various fertility concerns and endocrine issues as well as multiple types of malignancy have been linked to obesity. For these reasons, weight control by the use of dietary modification, exercise and more recently pharmacologic management has been strongly advocated.
Unfortunately, these methodologies have been in general unsuccessful in maintaining significant long-term weight loss in a large population of patients. Bariatric surgery offers an effective means to obtain weight loss, though it should be seen as only a very important component of a multi-faceted approach including exercise and nutritional support. The National Institutes of Health implemented guidelines in the early 1990’s which have evolved into the standard of care as to the current indications for weight reduction surgery:
- Patients should have a BMI of 40 Kg/m2 or greater
- Patients may have a BMI of 35 Kg/m2- 39.9 Kg/m2 and still be considered if they have medical co-morbidities resulting from their excess weight (diabetes, hypertension, etc…)
- Significant efforts at weight loss through nutritional and exercise regimens should be attempted and documented prior to surgical management
The above parameters should only be seen as a guideline as to who MAY be an appropriate candidate after a full review of their medical and surgical history by an experienced bariatric surgeon. Nutritional counseling, psychologic evaluation and general medical fitness all need to be factors in determining the role of operative management with ongoing open dialogue between the potential patient and the operative team.