Chapter 68 Bariatric and Metabolic Surgery

Obesity is becoming the plague of the twenty-first century. With overweight becoming the norm in most Western countries and developing countries, two-thirds of adults suffer from overweight or obesity. Bariatric surgery is the branch of surgery involving manipulation of the stomach and/or small bowel to achieve weight loss and control of obesity-related disease. Bariatric surgery leads to weight loss of 25–35% of body weight after 1 year, and sustained weight loss maintenance at 15–25% after 20 years. The phrases ‘metabolic’ or ‘diabetes’ surgery are increasingly being used in conjunction with, or instead of, ‘bariatric surgery’ owing to the highly effective way that surgery improves the metabolic syndrome, with weight loss being a welcome additional effect. A 2009 Health Technology Assessment report in the UK showed bariatric surgery to be cost-effective compared with non-surgical options. Eligibility criteria were first proposed by the US National Institutes of Health in 1991, when the obesity epidemic was first recognised.

Multiple Choice Questions
Weblinks

Journal articles

https://www.nejm.org/doi/full/10.1056/nejmoa066603/ (free)

One of the first large-scale publications to show survival benefit after gastric bypass in patients with severe obesity, in Utah, compared with a non-operated control population.

https://www.sciencedirect.com/science/article/abs/pii/S0140673615000756?via%3Dihub/ (paid)

Five-year results published in 2015 of an Italian randomised controlled trial of best medical therapy versus gastric bypass versus biliopancreatic diversion for patients with severe obesity. Surgical patients had better weight loss and glycaemic control.

https://onlinelibrary.wiley.com/doi/10.1111/joim.12012/ (free)

Summary of the overall long-term key results of the Swedish Obese Subjects study. At 20 years, surgical patients had better long-term survival and a decreased incidence of diabetes, myocardial infarction, stroke and cancer in women.

https://www.bmj.com/content/353/bmj.i1472.long/ (paid)

Summary BMJ article on evidence of why more bariatric surgery should be done on the NHS, highlighting inadequacy of service provision compared with European countries with similar health services.

https://link.springer.com/article/10.1007%2Fs11695-017-2845-9/ (paid)

Summary of the second report of the International Federation for Surgery of Obesity Global Registry. Demographic data are presented on 54 000 patients from 31 countries, showing the decrease in obesity-related disease from baseline at 1-year follow-up in operated populations.

Guidelines

https://www.nice.org.uk/guidance/cg189/resources/obesity-identification-assessment-and-management-pdf-35109821097925/ (free)

The 2014 National Institute for Health and Care Excellence guidance on body mass index thresholds for bariatric surgery. The threshold for operating on patients with early-onset type 2 diabetes was lowered to 30 kg/m2.

https://onlinelibrary.wiley.com/doi/full/10.1111/obr.13087/ (free)

British Obesity and Metabolic Surgery Society guidelines on perioperative and postoperative biochemical monitoring and micronutrient replacement for patients undergoing bariatric surgery. Comprehensive 2020 update.

https://link.springer.com/article/10.1007%2Fs11695-015-2041-8/ (paid)

National Institute for Health and Care Excellence-accredited commissioning guidance for weight assessment and management clinics: a model for a specialist multidisciplinary team approach for people with severe obesity. Multidisciplinary guidance for organisation of secondary care obesity services.

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