Physiologic, psychologic, and metabolic consequences of bariatric surgery

The successful management of obesity is essential to treat effectively its associated comorbidities such as systemic hypertension, diabetes, dyslipidemias, and obstructive sleep apnea. Current weight loss recommendations include reduced caloric intake, exercise, and pharmacologic treatments that often result in a minimal weight loss that is rarely maintained. Conversely, surgical procedures such as Roux-en-Y gastric bypass, adjustable gastric banding, vertical banded gastroplasty, or biliopancreatic diversion result in a more successful and maintained long-term weight loss. Bariatric surgery-induced weight loss is associated with improvements in cardiovascular risk factors such as systemic hypertension, hypertriglyceridemia, and low levels of high-density lipoprotein cholesterol. However, hypercholesterolemia does not appear to benefit from surgically induced weight loss. Patients also note improvement in associated respiratory comorbidities such as asthma and obstructive sleep apnea as well as diabetes. Although the risks of bariatric surgery are numerous, including gastrointestinal and respiratory complications and associated nutritional deficiencies, in an appropriately selected surgical candidate, as detailed by National Institutes of Health guidelines, the surgical treatment of obesity warrants serious consideration.