Rising rates of obesity lead to increases in bariatric surgery

With rising rates of morbid obesity, the number of bariatric surgery procedures is likely to increase as well, reports a paper in the October issue of Plastic and Reconstructive Surgery®, the official medical journal of the American Society of Plastic Surgeons (ASPS).

Because of their role in dealing with aesthetic problems after massive weight loss, plastic surgeons must understand the principles and expected benefits of bariatric surgery procedures—as well as the characteristics and potential medical risks of patients undergoing these procedures, according to the new review by Drs. Bruce Wolfe and Erin Gilbert of Oregon Health and Science University, Portland.

Rising Rates of Obesity Lead to Increases in Bariatric Surgery…
The authors reviewed and summarized the latest data on the use and outcomes of bariatric surgery for the management of morbid obesity. The rise of bariatric surgery parallels the rising rates of obesity in the United States. Drs. Wolfe and Gilbert point out, "In 1990, not one state had a prevalence of obesity greater than 15 percent, whereas in 2009, only Colorado and the District of Columbia had prevalence less than 20 percent."

Obesity increases the risk of a wide range of chronic health problems—highlighted by the recent surge in diabetes among overweight and obese children and adolescents. "Not only is obesity a significant risk factor for many [diseases], but it also is associated with an overall increase in mortality and a reduction in life span of 10 years," the authors write. Currently, bariatric surgery is considered for patients who are unable to achieve a five percent decrease in weight with diet and lifestyle modifications.

Drs. Wolfe and Gilbert review the three main options for bariatric surgery: adjustable gastric banding, sleeve gastrectomy, and "Roux-en-Y" gastric bypass. The expected percentage of excess weight loss is about 48 percent after adjustable gastric banding and 61 percent after sleeve gastrectomy and gastric bypass.

Gastric bypass is the most popular procedure because it results in greater weight loss and less weight regain. It also performs best in terms of resolving obesity-related diseases, such as diabetes, high cholesterol and high blood pressure. However, gastric banding is a reversible procedure that causes fewer long-term metabolic problems.

…And Rising Demand for Body Contouring
It's especially important for plastic surgeons to understand the concepts and outcomes of bariatric surgery procedures, as there is a fast-growing population of patients seeking body contouring surgery. Body contouring refers to several different types of plastic surgery procedures done to remove excess fat and skin in patients after massive weight loss. ASPS statistics show sharp increases in the demand for body-contouring procedures—such as lower body lift, upper arm lift, and abdominoplasty ("tummy tuck") over the past decade.

In general, body contouring should be delayed until weight has stabilized for at least three months—which may take a year or longer after surgery, according to Drs. Wolfe and Gilbert. They emphasize the need to carefully screen patients for ongoing medical issues such as diabetes, heart disease or obstructive sleep apnea. Nutritional deficiencies are also common after bariatric surgery, including protein malnutrition and deficient levels of nutrients such as vitamin B12, vitamin D, iron, calcium and folate. All of these conditions should be identified and corrected before body contouring is performed.

"Given the increasing incidence of morbid obesity and the effectiveness of bariatric surgery in treating this disease, it will likely continue to increase in popularity," Drs. Wolfe and Gilbert conclude. They believe that the growth of bariatric surgery may increase even further as the overall safety profile continues to improve. In addition, the number of adolescent patients undergoing surgical treatment for obesity is likely to increase as future studies verify the safety of bariatric surgery in this age group.