We may think of Covid 19 when we read the words “global health epidemic,” but there’s another one—obesity. This environmental disease affects millions of individuals worldwide and poses significant challenges to public health. Traditional methods of weight loss, such as dieting and exercise, and even programs that are medically supervised, simply don’t work for individuals with severe obesity. In recent years, metabolic surgery, also known as bariatric surgery, has gained recognition among medical societies like the American Heart Association as an effective and durable treatment option for obesity and its related comorbidities. As our understanding of the metabolic implications of obesity evolves, new guidelines for metabolic surgery have been developed as a means of improving patient outcomes and expanding the scope of this transformative intervention.
Why Metabolic Surgery?
Metabolic surgery refers to a range of surgical procedures aimed at inducing weight loss, reversing type 2 diabetes, and improving metabolic health in individuals with severe obesity. But why surgery? The motivation behind metabolic surgery is the understanding that obesity is not merely a result of overeating and sedentary behavior, nor is it a lack of willpower. Instead, it’s a complex metabolic disorder involving hormonal and neurobiological dysregulation. Metabolic surgery changes the anatomy of the gastrointestinal tract, resulting in weight loss and profound metabolic changes that extend beyond simple calorie restriction.
Outlining New Guidelines for Metabolic Surgery
- Patient Selection: The new guidelines for metabolic surgery emphasize the importance of appropriate patient selection to maximize the benefits and minimize the risks associated with the procedure. Historically, inclusion criteria generally include individuals with a body mass index (BMI) greater than 40 kg/m² or a BMI greater than 35 kg/m² with additional health conditions such as type 2 diabetes, hypertension, or obstructive sleep apnea. Appropriate candidates for metabolic surgery should have failed attempts at nonsurgical weight loss interventions and demonstrate a commitment to long-term lifestyle changes.
- Expanded Indications: Recognizing the potential metabolic benefits of surgery beyond weight loss, the new guidelines also expand the indications for metabolic surgery to include individuals with type 2 diabetes and a BMI as low as 30 kg/m². It’s a change in recognition of the mounting evidence that metabolic surgery can result in the resolution or improvement of diabetes, entirely separate from weight loss, through mechanisms such as enhanced insulin sensitivity, hormonal changes, and gut microbiota modulation. These expanded indications hold promise for a wider population of individuals struggling with obesity and its metabolic consequences.
- Surgical Options: Several surgical procedures fall under the umbrella of metabolic surgery, including gastric bypass, sleeve gastrectomy, biliopancreatic diversion, and duodenal switch. The choice of procedure should be individualized, taking into account factors such as the patient’s preferences, comorbidities, and anatomical considerations. Sleeve gastrectomy has gained popularity due to its relative simplicity and favorable outcomes. However, gastric bypass is highly effective as a revision option when the sleeve proves inadequate for achieving substantial weight loss and metabolic improvements in the long term.
- Multidisciplinary Approach and Long-Term Follow-Up: The guidelines emphasize the importance of a multidisciplinary approach to metabolic surgery, involving a team of healthcare professionals including surgeons, dietitians, psychologists, exercise specialists, and sometimes endocrinologists. This approach ensures comprehensive preoperative evaluation, shared decision-making, perioperative care, and long-term follow-up. Regular monitoring of nutritional status, hormonal parameters, and psychological well-being is advisable to optimize patient outcomes and address any potential complications or deficiencies.
- Risk-Benefit Analysis and Safety Measures: While metabolic surgery, like any surgical intervention, carries inherent risks, there is widespread acknowledgement that metabolic surgery lowers risks for individuals who are struggling with obesity. The new guidelines underscore the importance of performing a thorough risk-benefit analysis for each patient, considering the potential benefits of weight loss and metabolic improvements against the small risk of surgical complications.
The Bottom Line
The new guidelines for metabolic surgery represent a paradigm shift in the treatment of obesity and its metabolic consequences. By expanding the indications, promoting a multidisciplinary approach, and prioritizing long-term follow-up, these guidelines aim to enhance patient outcomes, improve quality of life, and mitigate the burden of obesity-related comorbidities. As our understanding of obesity continues to evolve, metabolic surgery stands as a transformative intervention that holds promise in combating the global obesity epidemic and improving public health on a broader scale.
In northern Nevada, the team at Nevada Surgical has a long track record of success with metabolic surgery. If you’re wondering whether you might be a candidate for weight-loss surgery, it’s normal to have questions. Contact us today and let’s discuss your options.
