Obesity (Bariatric) Medicine and Bariatric Surgery
Obesity Medicine (or Bariatric Medicine) is the field of medicine dedicated to the comprehensive care of patients with the disease of obesity. Obesity Medicine physicians use evidence-based approaches, such as nutrition, physical activity, behavior, and medications, to help patients lose weight and improve health.
Bariatric Surgery is a surgical field. Bariatric surgeons have special training to perform procedures that reduce the amount of food the stomach can hold which leads to weight loss. Some bariatric procedures also cause hormonal changes that help with weight management.
Bariatric Surgery
This is a surgical procedure that reduces the size of the stomach so that the individual can only absorb and process less food than before. There are several different versions of this procedure including bypass, removing a portion of the stomach, and lap bands.
The surgeries can be performed as a laparotomy where the surgeon makes a larger incision or laparoscopically that involves a camera inserted into a small incision. To attenuate the pain, the patient is given general anesthesia and in either surgery option, an overnight stay is standard for as much as a few days.
Options
The physician and medical team will evaluate the individual's appropriateness for the different surgical options.
Gastric balloon – This is where a deflated balloon is placed in the stomach. When inflated, the size of the stomach is reduced. This is not a surgical procedure but is an invasive procedure.
Lap Band – This is also known as an adjustable gastric band and is a silicone strip that is placed around the stomach. It also reduces the capacity of the stomach. This is a laparoscopic procedure with a port just under the skin so the band can be adjusted as necessary.
Vertical banded gastroplasty - It is commonly called stomach stapling or a Mason procedure. The stomach is stapled to make it smaller.
Vertical Sleeve Gastrectomy – This is when a portion of the stomach is surgically removed, leaving it shaped like a sleeve.
Gastric Bypass – The surgeon will cut the opening of the small intestine and reattach it to the upper portion of the stomach. Some bypass options include removing a portion of the stomach.
Risks
All surgeries carry an inherent risk, including a reaction to the anesthetic. For bariatric surgery, there is the possibility of other issues including bleeding, bowel obstruction, malnutrition, adhesions, reflux disease, and others. Malnutrition is one major concern because the stomach is physically smaller and nutrients may not be absorbed properly.
There can also be accompanying emotional or psychological issues. Being unable to enjoy the food or quantity as in the past or depression. Many bariatric surgeons include a psychologist as part of the team. Family members are encouraged to be part of the process.
Medical supervision by a trained physician in obesity medicine before and after bariatric surgery is important for successful weight management, to avoid weight regain, and to monitor and assess for any signs of malnutrition.
