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Concept
Bariatric surgery
Summary
Bariatric surgery (or weight loss surgery) is the medical term for a variety of procedures dealing with obesity. Long term weight loss through the standard of care procedures (Roux en-Y bypass, sleeve gastrectomy, and biliopancreatic diversion with duodenal switch) is largely achieved by altering gut hormone levels responsible for hunger and satiety, leading to a new hormonal weight set point. Bariatric surgery is the most effective treatment causing weight loss and reducing complications of obesity.
As of October 2022, the American Society of Metabolic and Bariatric Surgery (ASMBS) and International Federation for the Surgery of Obesity (IFSO) recommend bariatric surgery for adults with a body mass index (BMI) >35, regardless of obesity-associated conditions, and recommend considering surgery for people with BMI 30.0-34.9 who have metabolic disease. This reflects an October 2022 change in guidelines, so other guideline-producing organizations and health insurance plans may take time before their guidelines are updated. Similarly, the American Academy of Pediatrics (AAP) recommends bariatric surgery for adolescents 13 and older with a BMI ≥120% of the 95th percentile for age and sex.
Bariatric surgery can have significant health benefits in addition to weight loss, including improvement in cardiovascular risk factors, fatty liver disease, diabetes management, and reduction in mortality. Long-term studies from 2009 show the procedures result in significant long-term loss of weight, recovery from diabetes, improvement in cardiovascular risk factors, and a mortality reduction from 40% to 23%. A meta-analysis in 2021 found that bariatric surgery was associated with 59% and 30% reduction in all-cause mortality among obese adults with or without type 2 diabetes, respectively. This meta-analysis also found that median life-expectancy was 9.3 years longer for obese adults with diabetes who received bariatric surgery as compared to routine (non-surgical) care, whereas the life expectancy gain was 5.
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