Have You Considered Bariatric Surgery?

Bariatric Surgery: Who Is It For?

Bariatric surgical procedures, such as gastric bypass or sleeve gastrectomy, aid in weight loss and are considered when traditional methods, primarily diet and exercise, prove insufficient. The genetic component of obesity has been highlighted in numerous studies. However, given the multifactorial nature of obesity, it's likely that there are also combined genetic factors that may or may not influence the ability to lose weight and maintain weight loss.

Bariatric surgery is considered when obesity poses a significant health risk. However, surgery isn't suitable for everyone; specific criteria must be met. Beyond determining surgical feasibility, the medical team must assess achievable outcomes. Bariatric surgery alone doesn't guarantee weight loss; adhering to a strict nutritional plan and exercise program is crucial for long-term success.

Psychologically, obesity can profoundly disrupt a person's life: obese individuals often experience isolation and social stigma, hindering socialization. Overweight children, in particular, may develop strained relationships with their bodies and peers, leading to isolation and potentially reinforcing sedentary habits.

When Do You Suffer From Obesity?

Overweight is characterized by excessive body fat accumulation, usually due to poor diet and a sedentary lifestyle. Nutrition and physical activity are significantly influenced by social, economic, and cultural factors. Obesity and overweight are linked to premature death and are universally recognized as risk factors for major chronic diseases. A particularly serious concern is childhood and adolescent obesity, exposing young people to breathing difficulties, joint problems, reduced mobility, and digestive and psychological disorders. Furthermore, childhood obesity often persists into adulthood, increasing the risk of cardiovascular risk factors (hypertension, coronary artery disease, stroke) and metabolic disorders like type 2 diabetes or hypercholesterolemia.

Obesity is defined as an excessive accumulation of body fat relative to lean body mass, considering both absolute quantity and distribution. Body fat distribution can be measured using various methods, from skinfold thickness and waist-to-hip ratio to more sophisticated techniques like ultrasound, CT scans, or MRI. Population classification based on weight uses the Body Mass Index (BMI, according to the American definition), considered the most representative indicator of excess body fat. BMI is calculated as: BMI = weight (kg) / height squared (m²)

Adult weight classes based on BMI are:

• < 18.5: underweight;
• 18.5 - 24.9: normal weight;
• 25 - 29.9: overweight;
• >=30: obesity;

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Who Is Eligible for Bariatric Surgery?

Initial candidate selection for bariatric surgery is clinical and requires the following:

• Weight overload accompanied by related complications, such as hypertension, sleep disorders, or diabetes;
• A Body Mass Index (BMI) of 30 or greater;
• Failure of traditional weight loss methods (specialist-supervised diet and physical activity);

The medical team, potentially including a bariatric surgeon, psychologist, nutritionist, and others, evaluates the advantages and disadvantages of bariatric surgery based on individual characteristics. Surgery proceeds only if potential benefits outweigh risks.

Here are factors influencing the medical team's decision:

• General health and medical history: Pre-existing conditions (e.g., blood clots, alcoholism, kidney problems, nutritional disorders) can lead to surgical complications or exacerbation of existing issues;
• Nutritional history: The individual's ability to adhere to a diet is crucial; past dietary attempts and their outcomes are carefully evaluated. Surgery is only considered if other methods have failed;
• Psychological evaluation: Bariatric surgery requires a stable psychological state; conditions such as anxiety, depression, or PTSD can negatively impact outcomes;
• Motivation assessment: Strong motivation to radically change lifestyle and adhere to a strict dietary plan is essential;
• Age and associated pathologies: Bariatric surgery is generally not recommended at advanced ages or before age 18. Ideal candidates are aged 18 to 65 with class III obesity (BMI > 30);

It's important to remember that various bariatric surgery options exist. Each case is unique, and a skilled bariatric surgeon tailors the intervention to the patient's needs. For significant weight loss, procedures like gastric bypass or sleeve gastrectomy may be considered, while less invasive options such as gastric banding or a gastric balloon may be appropriate for more modest weight loss goals.

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