Bariatric surgery: An overview.
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Date
2014-09
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Abstract
Obesity is a global epidemic. Its prevalence is increasing rapidly
and India is no exception.1
Obesity is not only a cosmetic problem
but is associated with a number of diseases including type 2
diabetes mellitus (DM), hypertension, obstructive sleep apnoea
syndrome (OSAS), polycystic ovarian disease syndrome (PCOS)
and non-alcoholic fatty liver disease (NAFLD). It is also a risk
factor for a number of malignancies. Obese persons tend to have
a shorter life span when compared to an age-matched normal
population. Among the options for weight reduction, dietary and
lifestyle modifications are generally advised as the first line of
treatment. A large amount of scientific literature has suggested
beyond doubt that non-surgical treatment of morbid obesity does
not lead to a meaningful weight loss.2–5 Almost all (90%–95%)
those who do lose significant weight regain it.3
As far as
pharmacotherapy is concerned, there is almost nihilism. Most of
the drugs have been withdrawn due to side-effects. Even after
discounting for side-effects, these medicines lead to a nominal
weight loss of only 5–10 kg. In 10-year data reported by the
Swedish Obese Subject (SOS) study, weight loss in the nonsurgical
group was minimal compared to that in the surgical group
(1.5% v. 25%).4
This non-randomized study included over 4000
patients and the 5-year mortality rate in the surgical group was
significantly lower than that in the non-surgical group (0.68% v.
6.17%).4
We often come across patients who initially refuse surgery due
to fear of complications but later seek surgery. During this period
they gain more weight and the comorbid conditions worsen.
Bariatric surgery provides a means for considerable weight control
and has also been effective in the resolution of obesity-related comorbid
conditions.5
The long-term mortality due to obesity also
decreases after bariatric surgery.4
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Citation
Aggarwal Sandeep, Uniyal Madhur. Bariatric surgery: An overview. National Medical Journal of India. 2014 Sept-Oct ; 27(5): 261-266.