Obesity is a growing disease both in the US and around the world. It is a major cause of many diseases including diabetes, hypertension, heart disease, cancer, cerebrovascular disease and stroke, gastroesophageal reflux disease, bone and joint damage and respiratory disorders. It also places individuals at increased risk of developing serious complications from COVID-19.
Severe obesity is one of the most dangerous stages of obesity. Over 20 years ago, the National Institutes of Health (NIH), released a report that individuals with severe obesity are often unable to maintain weight loss through conventional techniques like decreased calorie consumption, increased exercise or other weight loss programs. At that time, the NIH stated that bariatric surgery was the most effective long-term treatment for severe obesity.
Over the years, bariatric surgery has transformed from large open procedures requiring a hospital stay and long recovery to minimally invasive procedures done either laparoscopically or robotically. There are multiple options for patients including gastric bypass, gastric sleeve and revisional procedure for those who may have tried prior surgical interventions.
Bariatric surgery results in weight loss by altering the gastrointestinal anatomy to reduce appetite while increasing satiety by affecting the production of intestinal hormones. This results in weight loss by not only limiting the amount of food consumed in meals, but also decreasing the desire to eat in ways not obtainable by dietary or pharmacologic weight loss.
With the innovations in surgery, bariatric surgery has become increasingly safe and accessible. Bariatric surgery now boasts a lower complication and mortality rate than even routine gallbladder surgeries or hip replacement. The most recent advancements in the field result from the robotic surgery platform. This allows bariatric surgery to overcome many constraints due to body habitus and have superior 3D visualization with full, wristed manipulation of the surgical instruments. Robotic instruments also have tissue monitoring mechanisms to ensure safe use of the instruments.
In addition to weight loss, bariatric surgery patients may also have improvements in many obesity-related diseases. Perhaps the most common disease state treated with bariatric surgery is Type II diabetes mellitus. This disease, long described as a progressive and incurable condition, is treated and often cured with bariatric surgery. Remission of diabetes is often quoted at around 80 percent for bariatric surgery, regardless of procedure chosen.
The exact mechanism of the remission and cure rates of diabetes with bariatric surgery is not entirely understood. Certainly, there is a relation between the amount of weight loss and the degree of remission, but often the remission occurs early on following surgery, before there is any real weight loss. In fact, many patients undergoing bariatric surgery leave the hospital the day following surgery with normal blood sugars, not on any of their prior diabetic medications.
With the rise in both obesity and diabetes in the United States, bariatric surgery is the most effective treatment for both of these diseases. Surgery has become increasingly safe with improvements in minimally invasive methods. Patients postoperatively boast non-medical improvements such as improvements in mobility, self-esteem, social interactions and work. Bariatric surgery should be encouraged as an option for patients with obesity and obesity-related diseases.
Andrew M. Dewitt, MD practices bariatric and robotic general surgery at Norwood Clinic.
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