Which Patients Should be Offered Bariatric surgery?
Which patients should be offered bariatric surgery?
The first-line management of obesity should include a multi-disciplinary evaluation with nutritional and medical counseling, according to the patient’s need, in collaboration with an experienced consultant and surgical team. Many of our global surgeons suggest that adjustable gastric banding not be offered due to unacceptable complications and long-term failure. Some bariatric specialists recommend that single-anastomosis gastric bypass not be routinely offered, due to long-term complications in comparison with standard Roux-en-Y gastric bypass (Level 4, Grade D).13 • Different surgical options exist (e.g., sleeve gastrectomy, gastric bypass, and duodenal switch), with different levels of effectiveness. We recommend patients considering bariatric surgery schedule a teleconsultation and have an extensive discussion with the surgical team before deciding which surgical option seems to be the best for them. All surgeries have some adverse effects and potential risks and require lifelong management to follow-up, mineral and vitamin supplementation, and behavioral changes. well as behavioral modifications and increased physical activity. Post-surgery we highly recommend our remote monitoring service to maintain good vitals that can be measured when returning home.
Ideal Bariatric Candidates
Patients with a BMI between 35 and 40 kg/m² with at least one major obesity-related disease (e.g., T2DM, obesity-related cardiac disease, sleep apnea), or patients with a BMI ≥ 40 kg/m² with or without associated diseases, are potential surgical candidates. In addition, bariatric surgery may be offered to patients with obesity (BMI ≥ 30 kg/m²) and significant obesity-associated disease(s), when psychological and behavioral interventions and medical management are insufficient to achieve optimal weight loss and control of comorbidities.
All potential bariatric patients are carefully evaluated by a bariatric surgeon once a second opinion or firmquote is completed. Following consultation, your bariatric surgeon may educate you regarding the risks, benefits, and alternatives to bariatric surgery. Patients should also understand the need for lifelong medical surveillance to prevent and correct potential long-term nutritional deficiencies after surgery. Contraindications for bariatric surgery include recent substance abuse (alcohol, drugs), non-stable psychiatric conditions (i.e., changes in psychiatric medications in the last six months), a diagnosis of cancer, or an expected life expectancy of fewer than five years.
Even though an age limit of 60 years is considered in the NIH recommendations, multiple studies have assessed the risks and benefits of bariatric surgery in the elderly. These are summarized in a systematic review that identified 26 articles encompassing 8149 patients.18 Pooled 30-day mortality was 0.01% and the overall complication rate was 14.7%. At the one-year follow-up, mean excess weight loss was 53.8%, diabetes resolution was 54.5%, hypertension resolution was 42.5% and lipid disorder resolution was 41.2%. The authors conclude that outcomes and complication rates of bariatric surgery in patients older than 60 years are comparable to those in a younger population, independent of the type of procedure performed.
Patients should not be denied bariatric surgery because of their age alone.
Next Steps
If you are considering bariatric surgery and would like to arrange a teleconsultation, or request a quote we would be pleased to support you with this and help you on your path to health and wellness. You can also review bariatric price guides here.
