ROBIN SCHROEDER, MD, DANIEL T. HARRISON, DO, AND SHANIQUA L. MCGRAW, MD
A more recent article on metabolic surgery for adult obesity is available.
Am Fam Physician. 2016;93(1):31-37
Patient information: See related handout on weight loss surgery, written by the authors of this article.
Author disclosure: No relevant financial affiliations.
In 2013, approximately 179,000 bariatric surgery procedures were performed in the United States, including the laparoscopic sleeve gastrectomy (42.1%), Roux-en-Y gastric bypass (34.2%), and laparoscopic adjustable gastric banding (14.0%). Choice of procedure depends on the medical conditions of the patient, patient preference, and expertise of the surgeon. On average, weight loss of 60% to 70% of excess body weight is achieved in the short term, and up to 50% at 10 years. Remission of type 2 diabetes mellitus occurs in 60% to 80% of patients two years after surgery and persists in about 30% of patients 15 years after Roux-en-Y gastric bypass. Other obesity-related comorbidities are greatly reduced, and health-related quality of life improves. The Roux-en-Y procedure carries an increased risk of malabsorption sequelae, which can be minimized with nutritional supplementation and surveillance. Overall, these procedures have a mortality risk of less than 0.5%. Cohort studies show that bariatric surgery reduces all-cause mortality by 30% to 50% at seven to 15 years postsurgery compared with patients with obesity who did not have surgery. Dietary changes, such as consuming protein first at every meal, and regular physical activity are critical for patient success after bariatric surgery. The family physician is well positioned to counsel patients about bariatric surgical options, the risks and benefits of surgery, and to provide long-term support and medical management postsurgery.
Obesity is a disease that has serious physical, psychological, and economic implications for patients, and poses major challenges for the physicians caring for them. 1 Approximately 35% of the U.S. adult population is obese. 2 Obesity affects every organ system (Table 1 1 , 3 – 5 ); the related pathologic processes create a health burden for patients and an economic burden for the health care system. The U.S. Preventive Services Task Force recommends screening all adults for obesity. Patients with a body mass index (BMI) of 30 kg per m 2 or higher should be offered or referred to intensive, multicomponent behavioral interventions. 6 These interventions can result in clinically significant weight loss (5% or greater) in patients with obesity and can be initiated by the family physician. 6 Surgical treatment of obesity results in greater weight loss, greater reduction in comorbidities, and prolonged survival compared with nonsurgical interventions. 3 , 7 – 9 Recent emphasis has shifted from weight loss outcomes to the metabolic effects of these surgical procedures. 10 Family physicians are well positioned to counsel patients about bariatric surgical options, as well as provide long-term support and medical management postsurgery.