Obesity is a steadily growing global epidemic affecting over one-third of the USA adult population. These trends are expected to continue to reach 51% of the adult population by 2030.
More than 40% of the USA adults have obesity, and more than 9% have severe obesity, which may increase the risk of developing certain health issues such as:
- Heart disease
- Liver disease
- Type 2 diabetes
- Kidney disease
Consequently, the demand for bariatric surgery has increased significantly in many countries and is projected to increase, along with an expected increase in the obese population.
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Obesity/Bariatric Surgery in the USA
Patients can lower their risk of developing these health problems through weight loss. Losing weight and maintaining it can be challenging for individuals with severe obesity, even with diet and exercise. Bariatric surgery may be a useful option for such individuals.
Bariatric procedures increased 5-fold, from 6.3 per 100,000 in 1998 to 32.7 per 100,000 in 2002. The number of bariatric surgeons increased by 144%, as did the number of bariatric centers, which increased by 146%.
The incidence of open surgery showed a dramatic decrease over time, paralleled by a substantial increase in laparoscopic surgery, representing 90% of overall bariatric surgeries in 2008.
Over the years, bariatric surgery has become safer, less invasive, and more common. Over 250,000 bariatric surgery operations were performed in the USA in 2018.
Effect of Excess Weight on Patient's Life
The excess weight affects quality of life, productivity, and longevity. It is associated with the costliest major health comorbidities, including type II diabetes mellitus, hypertension, obstructive sleep apnea, asthma, cardiovascular events, and some cancers.
In addition to the direct costs, patients with obesity and chronic diseases who undergo surgical procedures have higher rates of complications and longer hospital lengths of stay, adding to an already significant burden on healthcare resources.
Bariatric Surgery: A Boon for Obese Patients
While metabolic surgery has proven to be the most effective treatment for obesity and obesity-related comorbidities, it remains significantly underutilized. Bariatric surgery can prevent, slow down the progression, or even reverse certain health conditions related to obesity, including:
- Obstructive Sleep Apnea
- Type 2 Diabetes
- Gastroesophageal Reflux (GERD)
- Degenerative Joint Disease (Osteoarthritis)
- Coronary artery disease (CAD)
- Chronic back pain
- Hypertension
- Fatty liver disease
Emerging Technologies: The Introduction of New Technologies into Bariatric and Metabolic Surgery
Many new bariatric/metabolic surgeries have been introduced in the past decade.
Duodenojejunal Bypass (DJB)
Simple exclusion of the duodenum was less effective than conventional bariatric/metabolic surgery. Therefore, duodenojejunal bypass with sleeve gastrectomy (DJB-SG) has been introduced as a novel metabolic surgery by adding a duodenal switch procedure to SG. This duodenal switch combines the principles and advantages of sleeve gastrectomy and duodenal switch. The efficacy of DJB-SG is similar to conventional gastric bypass.
Advantage of DJB-SG:
- Avoids the risk of gastric cancer arising from the remnant stomach by leaving no excluded stomach.
- Related to preserving the pylorus, which includes preventing dumping syndrome and facilitating iron, calcium, vitamin B12, and protein absorption by preserving the acid and intrinsic factor.
- By adding a duodenal exclusion to SG, DJB-SG can increase weight loss by more than 10%, improve glycemic control, and reduce uric acid levels.
Single Anastomosis Duodeno-Ileostomy (SADI)
SADI is a simplified biliopancreatic diversion/duodenal switch (BPD/DS) using a loop anastomosis replacing the RY anastomosis of the duodenal switch.
Similar modification was laparoscopic single anastomosis for DJB. Both procedures are a simplified version of the original operation by replacing the RY reconstruction with loop anastomosis, as is SAGB to RYGB.
Neuromodulation
This entails utilizing an electrical pulse generator (similar to a heart pacemaker) to deliver a patterned electrical impulse to a target on the gastrointestinal tract. That target could be the stomach, the intestines, the nerves, etc. The impulse can stimulate or enhance normal electrical activity or block it.
Top Hospitals in the USA for Obesity/Bariatric Surgery
Cedars-Sinai Medical Center, Los Angeles
The Cedars-Sinai Center for weight management and metabolic health offers a range of surgical and nonsurgical interventions for significant weight loss. The surgeons specialize in performing a wide range of bariatric surgeries and procedures, including:
- Roux-en-Y Gastric Bypass
- Gastric Sleeve
- Gastric Band Surgery
- Duodenal switch
- Biliary pancreatic diversion
Additionally, expert gastroenterologists perform endoscopic (nonsurgical) bariatric procedures, including:
- Endoscopic sleeve gastroplasty (ESG)
- Trans-oral-outlet reduction (TORe)
- Endoscopic revisions of bariatric surgery
- Intragastric balloons
NYU Langone Hospitals, New York
NYU Langone has a team of weight management experts that includes internists that specialize in obesity, registered dietitians who assist in meal planning, endocrinologists, doctors who treat hormone conditions, and bariatric or weight loss surgeons. These specialists work together to create a personalized plan to help you lose weight and prevent or manage obesity-related conditions.
NYU Langone offers a range of bariatric surgeries to assist individuals in reducing their portion sizes, curbing hunger, and limiting calorie intake. These procedures are recommended for those aiming to lose approximately 50% of their body weight.
Massachusetts General Hospital, Boston
The Massachusetts General Weight Center has a team of skilled surgeons specializing in treating obesity through personalized consultation and advanced medical and surgical programs.
Each surgeon is a board-certified Harvard Medical School-affiliated, specializing in treating patients with complex medical disorders related to weight disorders, obesity, and metabolic disease.
Blue Cross Blue Shield of Massachusetts recognizes Massachusetts General as a distinguished Blue Distinction Center for Bariatric Surgery. This designation is given to healthcare facilities that excel in providing specialized care.
Stanford Health Care-Stanford Hospital, Stanford, California
The BMI Clinic at Stanford Health Care-Stanford Hospital was Northern California's first Center of Excellence to achieve Level 1A certification by the American College of Surgeons. Stanford's Bariatric Surgery Clinic is also Northern California's first Center of Excellence to achieve Level 1A certification by the American College of Surgeons.
Barnes-Jewish Hospital, St. Louis
The hospital provides a comprehensive program for weight loss in a convenient, comfortable setting. Their Washington University lead bariatric surgeon has performed over 3,500 surgeries, currently 400 per year, almost all with a laparoscopic (minimally invasive) approach. They offer FDA-approved, nonsurgical, minimally invasive endoscopic procedures that provide safe, effective weight-loss treatment options.
The bariatric surgeons and gastroenterologists at the hospital come from Washington University and are at the forefront of weight loss research. The hospital has been recognized by the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) for meeting or surpassing national standards.
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Key Takeaway
Bariatric surgery offers a much-needed, long-term solution to a problematic, progressive disease. Obesity is very hard to beat, and without intervention, it seriously affects your health, quality of life, and lifespan.
Bariatric surgery can change the biological factors that make it so hard for people with obesity to lose weight and keep it off. While surgery can have its own risks and complications, in most cases, these are much lower than the risks and complications of obesity and its related diseases.
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