Bariatric Surgery: A Perspective for Primary Care

Abstract

Bariatric surgery is the most effective treatment for obesity, type 2 diabetes, and comorbidities associated with obesity. In this article, the authors review the current indications for bariatric surgery and discuss the most common procedures. They analyze the medical results of bariatric procedures by reviewing key possible trials and discussing changes in physiology following these procedures. They conclude by discussing the long-term management of bariatric patients by reviewing the current guidelines on dietary support and by listing the common difficulties associated with these procedures.

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Obesity is a global pandemic affecting nearly 2.1 billion adults worldwide. In the United States, more than a third of adults are obese. The accumulation of snow is linked to hyperactivity, impaired insulin sensitivity, a tendency to thrombosis, inflammation, and endothelial malfunction, leading to increased risk of cardiovascular disease, non-alcoholic liver disease (NAFLD), and type 2 diabetes. Moderate weight loss among people has been shown to improve overall obesity. Unfortunately, recidivism of weight and relapse are common among patients undergoing weight loss medical management.

Bariatric surgery is currently the most effective long-term treatment for weight loss and improvements in diseases associated with obesity. While bariatric surgery is becoming safer with advances in laparoscopic and endoscopy technologies, it is always invasive and life changing and there are many short and long term difficulties. A number of mechanisms for bariatric surgical efficiency have been expressed, which may provide useful pharmacological targets to bridge the gap between future medical and surgical management of obesity.

To help primary care providers (PCPs) manage patients with bariatric surgery and patients who refer correctly and who may benefit from bariatric surgery, we review the current signs of bariatric surgery, procedures. common, short-term and long-term common difficulties, and current proposed mechanisms that increase the effectiveness of surgery.

Indicators for Bariatric Surgery

Current indications for surgery are shown. The National Institutes of Health first developed in 1991 as a parallel statement that the indications adopted since then have not changed significantly. However, periodic reviews were carried out and published by related associations.

Indicators for Bariatric Surgery

Patients should be considered for referral to a bariatric surgical center if there is a current BMI of ≥40 kg / m2 or BMI of 35.0-39.9 kg / m2 with at least one condition, including type 2 diabetes,  lame sleep apnea, hypertension, NAFLD, and others There is evidence from Asian trials that support the extension of the criteria for bariatric surgery to patients with type 2 diabetes who cannot be controlled or metabolic syndrome and BMI of 30.0-34.9 kg / m2. However, the long-term effects of surgery in this population are not known.

Importantly, there are some contraindications to bariatric surgery that must be addressed before undertaking functional intervention. Medical conditions, including severe coagulopathy and cardiac / lung diseases, may prevent the surgical and anesthetic risks associated with a procedure. Another important consideration is the patient’s mental well-being to change this intervention. A thorough psychiatric evaluation is required to show mental illness, drug or alcohol abuse that is undiagnosed or untreated, inadequate social support, and inability to observe lifelong nutritional needs. Inadequate psychological assessment can lead to reduced metabolic efficacy and significant long-term morbidity.

As part of the pre-operative assessment of patients being considered for metabolic surgery, it recommends or requires some bariatric preset weight loss, and uses a majority meal replacement plan prescribed with protein chips or similar regime during the 2 weeks before surgery. The rationale behind secondary loss includes potential mitigation of operational difficulties with moderate weight loss, reduction of liver size before surgery, and production period of ability to comply with strict nutritional requirements after the operation. Some insurance plans require patients to lose some weight before bariatric surgery. We need a minimum weight loss of 10 lb (4.5 kg) following the initial consultation of the patient’s dietitite before we complete the plans for bariatric surgery.

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