Obesity is one of the most serious twenty-first century public health problems. Approximately 2.8 million deaths a year occur worldwide due to being obese or overweight.
Hereditary genetic changes more likely impact obesity developing at a young age. Adult obesity, on the other hand, is more likely due to a strong environmental component. This complex interaction between the biological component) and other environmental factors play a critical role in the development of obesity.
Obesity is simply defined as an excessive or abnormal accumulation of body fat that may cause significant health impairment. The World Health Organization (WHO) states that any individual with a BMI (body mass index) greater than or equal to 30 kg/m2 is considered obese. Severe obesity, on the other hand, is described as a BMI of greater than or equal to 40 kg/m2. The current US guidelines recommend consideration of bariatric surgery for individuals who have not responded to less invasive/non-surgical treatments if they have a BMI of at least 40, or those who have a BMI of at least 35 if they also have a serious disease related to obesity such as heart disease or diabetes.
Bariatric or weight loss surgery originated in the 1950s with the intestinal bypass, which was the first effective surgery for weight loss in the U.S. However many patients developed complications and through ingenuity of medical professionals, various types of surgeries were proposed and developed with modifications to the original procedures and the development of new techniques, which led to the establishment of less invasive techniques like laparoscopic and endoscopic technologies and surgeries.
With continued improvements in our knowledge of obesity and different treatment modalities, the advantages of bariatric surgery were fully understood and realized, and today surgery typically rivals and supersedes the health benefits of non-surgical therapy and treatments.
Even if patients are clearly motivated to change, potential barriers to weight loss still exist. Some barriers include social pressure, stress, depression, and other environmental, social, or emotional factors. Diet or non-surgical measures may work in some cases but for some individuals, these barriers may prove to be too difficult to deal with.
Severe obesity is often associated with several medical problems. The lines of causality are often complicated with medical problems causing severe obesity and vice versa with obesity causing medical problems, as well as a sedentary lifestyle or poor diet causing both medical, psychiatric problems, and obesity. These conditions have reduced life expectancy, and are also subjected to unwanted social, psychological, and physical disadvantages.
To make it simple, the term obesity itself implies a health risk. For this reason, prevention and treatment of obesity is now a worldwide priority. The aim of treatment is to reduce morbidity and mortality while improving psychological well-being and social function. The National Institute of Health (NIH), acknowledged bariatric surgery as the only effective treatment modality to prevent further weight gain and consequently contribute to significant weight loss.
Considered as the ‘gold standard’ of bariatric surgery, gastric bypass involves creation of a small stomach pouch; and direct connection of the first portion of the small intestine to the newly created pouch. This procedure will change how the stomach and small intestine react to food. This means that the surgery will cause feeling of fullness (reduce appetite), less food absorption, and consequently less weight.
Sometimes referred to as ‘sleeve gastrectomy’, this procedure is performed by removing a larger portion of the stomach. Instead of a small rounded pouch (like the one created for a gastric bypass), the remaining smaller portion of the stomach is a tubular pouch that resembles a shape of a banana. Evidence from short-term studies show that sleeve gastrectomy is as effective as gastric bypass in terms of reducing weight. Sleeve gastrectomy also causes changes in gut hormones that aids in suppression of hunger, reduction of appetite and improvement of satiety.
The Biliopancreatic Diversion with Duodenal Switch, as the name implies, is composed of two components. The first component is the creation of a small pouch by removing a part of the stomach. The second is bypassing a large portion (approximately three-fourths) of small intestine. A segment of the distal small intestine is then connected to the newly created stomach pouch, so that when the patient eats, the food passes through the shortened tubular stomach pouch and empties directly into the last segment of the small intestine. Although biliopancreatic diversion with duodenal switch is still a primary bariatric procedure, it is often reserved for super obese individuals and as a revision surgery following the failure of other methods.
Commonly called the lap band – this procedure involves the use of an adjustable band that is placed around the upper portion of the stomach, creating a smaller stomach pouch. The size of the opening between the pouch and the remainder of the stomach created by the adjustable band determines the amount of food that the stomach can hold. It can be adjusted by filling the gastric band with a sterile saline, which is injected through a port positioned beneath the skin.