The term “bariatric surgery” covers the surgical measures that contribute to weight loss in severe obesity.
Surgical procedures that change the anatomy of the digestive tract, such as gastric bypass, sleeve gastrectomy (gastric sleeve) and gastric banding, are grouped together under the term “bariatric surgery”. These procedures are now routine operations and have been offered at countless centres in Europe since the early 2000s, performed using minimally invasive methods (laparoscopic surgery). While the number of sleeve gastrectomies in Europe has been increasing in recent years, gastric banding is being abandoned because of its high complication rate. In certain cases, however, this method still has advantages over the two more radical surgical procedures. As a result of the anatomical changes to the digestive tract, the feeling of satiety or fullness comes more quickly and more intensely, so the desire to eat is reduced. This effect can be regarded as the direct effect of surgery. In severely obese patients, bariatric surgery contributes to weight loss not only through changes to the anatomy of the gastrointestinal tract. The surgical procedures also indirectly bring about hormonal changes in the body’s physiology. These hormonal changes appear to be the reason for the long-lasting effect of bariatric surgery. Furthermore, the interplay of hormones such as insulin, cortisol, leptin and dopamine, among others, triggers a more sustained and physiological increase in total energy expenditure. In comparison with the usual conservative method of losing weight through diet and reduced calorie intake, the so-called basal metabolic rate is maintained or even increased after bariatric surgery. This means that the patient’s total energy expenditure – i.e. daily calorie consumption – remains high. Through the reduction in the feeling of hunger and its intensity, as well as through faster success, the patient’s behaviour subsequently changes in the long term and in a lasting way. According to studies, about 89% of patients can lose at least 50% or more of their excess weight after a surgical procedure and maintain this weight loss. Which surgical procedure is best suited to which patient is decided by the general or visceral surgeon. In addition to clinical and laboratory examinations such as of the hormone balance, the comprehensive treatment of an obese patient also includes intensive nutritional counselling and exercise therapy.Long-term effects of bariatric surgery
Increased life expectancy
Numerous studies have established the effects of the surgical procedures. Comparing different patient groups makes the effects clearer. Severely obese people who have undergone bariatric surgery have a significantly higher life expectancy than the comparison group without surgery. Reduced mortality As a result of weight loss and the body’s recovery, some diseases that are adversely affected by obesity regress. Above all, cardiovascular diseases, which are responsible for countless deaths, can be halted in their course or even cured. Remission of type 2 diabetes can also often be achieved. As a result of the improvement in general health, mortality falls after bariatric surgery. In some circumstances, these procedures are performed as life-saving emergency measures in cases of massive obesity.Related topics:
- What is post-bariatric surgery?
- Nutrition before bariatric surgery?
- Obesity surgery
