Metabolic and bariatric surgery for obesity: a review

The obesity epidemic in the United States is plaguing both the adult and pediatric population. As BMI increases, life expectancy drops. Metabolic and bariatric surgery can be an effective option for morbidly obese patients to enable substantial, sustained weight loss and result in improvement or resolution of comorbidities. The National Institutes of Health's criteria for bariatric surgery includes patients with a BMI of 35 and associated comorbidities, or a BMI of 40 and have failed conservative management. Currently, the common surgeries done in the United States are the laparoscopic Roux-en-Y gastric bypass, the laparoscopic adjustable gastric band, the biliopancreatic diversion with duodenal switch and the sleeve gastrectomy. Complications of the surgery are related either to the stapling, origin of the surgery or the implantable device. Optimal outcomes for patients are achieved with a Center of Excellence designated surgeon and designated facility, demonstrated operative skill, quality outcomes, multidisciplinary support, minimal complications and number of procedures completed. Insurance companies have seen the benefit of covering metabolic and bariatric surgery with comorbidity reduction and reduced health care costs. A multidisciplinary approach to postoperative care includes a dietician, exercise physiologist, psychologist and bariatric nurse coordinator as part of the bariatric surgery team. Metabolic and bariatric surgery pared with healthy food choices and regular exercise is imperative to achieve the desired goal of long-term weight loss and comorbidity resolution.