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Bariatrics is the branch of medicine that deals with the causes, prevention, and treatment of obesity[1]. Bariatric surgery has been a popular treatment in the war against obesity. Recent reports have found that 2.3% of the United States population has a body mass index greater than 40 kg/m2. This suggests that more than six million people are in the weight range for potential therapy with bariatric surgery (Holtz-Gray; Prevention). Candidates for this surgery have a few procedure options. The most effective is the Roux-en-Y surgery (Thirlby,M.D.; Journal of Gastrointestinal Surgery). This surgery utilizes stapling a portion of the stomach to reduce the size dramatically. A portion of the small intestine is bypassed in this surgery to reduce the number of calories that the body absorbs during normal digestion [2]. This requires a permanent lifestyle change. If a person eats or drinks more than the pouch can hold, vomiting or “dumping” can occur. Dumping is a term used to describe the symptoms that occur when the post-op patient has over eaten. The symptoms include nausea, cramping, diarrhea, sweating, and vomiting.

There is a difference between being overweight and obese. Overweight is defined as a total body weight over the recommended range for good health. Obese is a more serious degree of overweight (Penn Bariatrics). The body mass index measure of health is not always accurate. A very muscular person may be assessed as obese and an elderly person may be assessed as healthy although they are low body weight with high body fat. Only a doctor can properly assess an individual’s BMI. Before someone can become eligible for bariatric surgery, certain criteria must be met. The basic criteria found at the Pennsylvania University Hospital [3] is the following:

Patients must have:

  • Body-weight greater than 100 pounds or 45 kg above ideal body weight.
  • Body mass index (BMI) greater than 40 or BMI greater than 35 with medical complications related to obesity, including high blood pressure, diabetes, sleep apnea, or gallbladder disease.
  • A history of weight loss attempts consisting of supervised diets and exercise programs.
  • No indication of active alcoholism or major psychiatric disorder.

According to Catherine Guthrie, “The procedure often alleviates or eliminates many obesity-related conditions, such as hypertension, diabetes, sleep apnea, arthritis, narrowing of the arteries, and an increased risk of death from some cancers” (Health Magazine). This gastric bypass surgery, Roux-en-Y, has significantly improved the prognosis of people with an aggressive form of non-alcoholic fatty liver disease (NAFLD) known as non-alcoholic steatohepatitis (NASH). Depending on the definition, 85% to 95% of morbidly obese populations seem to have NAFLD. This is important because NAFLD can progress to cirrhosis. With obesity on the rise, non-alcoholic fatty liver disease is now considered to be the most prevalent liver diseases in the United States (http://www.medicinenet.com/fatty_liver/page2.htm). NASH is an inflammatory condition of the liver. If it occurs, it happens after fatty liver disease has developed. NASH differs from NAFLD in that inflammation causes damage to the liver’s cells, while simple fatty liver likely does not, experts say. Persons with type 2 diabetes may be predisposed to this condition. Bariatric surgery is a treatment for this condition. Patients with these conditions are advised to lose weight and this significantly benefits the liver. Many obesity related diseases are often reversed with this surgery.

Surgery also improves physical appearance and self-esteem. The surgery obviously will make the patient decrease immensely in size. Often times outward appearance dictates our personal truth. That is how we really feel about ourselves. After surgery many have reported lower levels of depression, increased self-esteem, and increased satisfaction in life. An article from the Nutrition Research Newsletter includes a study of how pre-op patients compared to post-op gastric bypass patients. This study proved that in most cases there was a significant increase in positive body image and self image. These patients were much happier with their outward appearance after surgery.

Bariatric surgery also comes with risks. Robert E. Brolin, M.D., of New Jersey Bariatrics warns that abdominal surgery risks include bleeding, infection, intestinal blockage, and problems associated with general anesthesia. The greatest and potentially fatal complication can come from leaks from the stomach or the intestine. Although there are risks associated with gastric bypass surgery, the popularity of the surgery is rising.

The term bariatrics was created around 1965 from the Greek root baro ("weight," as in barometer) and suffix -iatrics ("a branch of medicine," as in pediatrics).

References

"Bariatrics." The American Heritage Dictionary of the English Language.4th ed. Houghton, 2000. Bartleby.com. 2005. 14 Feb. 2006 <http://www.bartleby.com/61/84/B0078400.html>.

Dymek, M, et al. "Quality of Life After Gastric Bypass Surgery - Obesity—Quality of Life, Causes and Treatments." Nutrition Research Newsletter Dec. 2002. 14 Feb. 2006 fulltext.

Heart Disease Weekly Editors. "Complex Bariatric Methods have Higher Risk for Complications, but Good Long-term Outcomes." Health Insurance Law Weekly 25 Dec. 2005: 129. Lexis-Nexis.com. 2006. 15 Feb. 2006 <http://web.lexis-nexis.com>. Path: Bariatric; Gastric; Banding.

The Trustees of the University of Pennsylvania. Penn Bariatric Surgery Program: At Pennsylvania Hospital. Philadelphia, 2006. University of Pennsylvania Health System. 2006. The University of Pennsylvania . 14 Feb. 2006 fulltext.

John Muir Health. July 2001. 14 Feb. 2006 fulltext.

Bariatric procedures

  • Adjustable gastric band ("Lap band")
  • Duodenal switch ("Biliopancreatic Diversion")
  • Roux-en-Y gastric bypass surgery ("RNY")
  • Vertical banded gastroplasty surgery ("stomach stapling")

External links

  • American Society for Bariatric Surgery
  • A study published in The Medical Journal of Australia
  • Surgical treatment of morbid obesity: an update published by AETMIS (Agence d'évaluation des technologies et des modes d'intervention en santé), 2005, Québec
  • Resource for information about Bariatric Surgery

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