Bariatric and metabolic surgery: a shift in eligibility and success criteria

Abstract

The obesity epidemic, combined with the lack of available and effective treatments for morbid obesity, is a scientific and public health priority. Worldwide, bariatric and metabolic surgeries are increasingly being performed to effectively aid weight loss in patients with severe obesity, as well as because of the favourable metabolic effects of the procedures. The positive effects of bariatric surgery, especially with respect to improvements in type 2 diabetes mellitus, have expanded the eligibility criteria for metabolic surgery to patients with diabetes mellitus and a BMI of 30-35 kg/m(2). However, the limitations of BMI, both in the diagnosis and follow-up of patients, need to be considered, particularly for determining the actual adiposity and fat distribution of the patients following weight loss. Understanding the characteristics shared by bariatric and metabolic surgeries, as well as their differential aspects and outcomes, is required to enhance patient benefits and operative achievements. For a holistic approach that focuses on the multifactorial effects of bariatric and metabolic surgery to be possible, a paradigm shift that goes beyond the pure semantics is needed. Such a shift could lead to profound clinical implications for eligibility criteria and the definition of success of the surgical approach.

Ascertaining the Place of Social Media and Technology for Bariatric Patient Support: What Do Allied Health Practitioners Think?

“…Involvement with these innovations may have save time and money, improve existing preand post-operative bariatric surgical services, and engage with groups of patients who do not, or are unable to attend routine appointments, such as known DNAs and patients with mobility problems. Engagement with mobile apps and social media by patients, with the role of healthcare professionals in the latter clearly defined, there may also be opportunities for patients to be more actively involved in monitoring their progress after surgery, not just in terms of weight loss, but also diet, exercise and other aspects of general well-being, further broadening the perception of 'success' after surgery (17). The concerns and issues raised by AHPs with respect to the role of social media, mobile apps and technology in terms of adjuvant support tools for bariatric surgery should continue to be explored and evaluated.…”

The risk of kidney stones following bariatric surgery: a systematic review and meta-analysis

“…25 Bariatric surgery has been shown to be an effective treatment for weight loss. 26 However, different types of bariatric surgery carry individual risk of developing kidney stones as revealed in our meta-analysis. Although RYGB is considered as a mixed restrictive and malabsorptive procedure, standard RYGB (Roux-en-Y limb ¼150 cm) causes less malabsorption compared to very-long limb RYGB.…”

“…Although RYGB is considered as a mixed restrictive and malabsorptive procedure, standard RYGB (Roux-en-Y limb ¼150 cm) causes less malabsorption compared to very-long limb RYGB. 26,27 However, studies have still found significant hyperoxaluria in patients following Figure 1. Outline of our search methodology.…”

“…Purely restrictive bariatric procedures are not as effective as other weight loss (pure malabsorptive or mixed restrictive/malabsorptive) procedures. 26 However, they do not cause hyperoxaluria. 28 Although restrictive procedures may limit fluid intake, which may increase the risk of kidney stones 30,31 the effect of weight loss also reduces the risk of kidney stones.…”

Laparoscopic Sleeve Gastrectomy Significantly Increases Serum Lipoprotein Lipase Level in Obese Patients

“…Furthermore, the frequencies of using metformin and statin, which were known to increase preheparin LPL level [18, 31], became significantly lower in the LSG group than the nonsurgical group after 12 months, although the preheparin LPL level increased only significantly in the LSG group. Several reports have described that bariatric surgery (or metabolic surgery) improved obesity-related metabolic disorders, especially diabetes, beyond simple weight loss [32-34]. Some studies have suggested mechanisms involved in the beneficial effects of bariatric surgery on obesity-related metabolic disorders beyond simple weight loss.…”