Diet is undeniably something that most of us at least at some point in our lives have tried with various rates of success. Yet up until recently it has been diet and exercise alone that have been marketed as the frontiers of weight loss in the clinically obese. But is there another option? Is there an easier alternative? Well the answer to this is yes and comes in the form of bariatric surgery. You may be familiar with the term and may in fact herald closer associations with the names tummy tuck or gastric banding. But these aren’t new concepts you say, perhaps you even know of someone who has had this done in the recent past. Well yes although this is not a new weight loss technique, up until now there has been little in the way of evidence to compare diet and other weight loss strategies versus bariatric surgery amongst severely obese patients.
The number of Americans with clinically severe obesity is on the rise and this has extremely detrimental implications for the nation’s healthcare system. This is because highly obese patients have around twice as many chronic health conditions such as heart disease, diabetes and lung disease than do their averagely weighted counterparts. Although this is a well-established fact in the medical community there has been much debate regarding the best way to deal with this growing patient population. New evidence comprises a review of literature encompassing various types of weight loss programs, results from studies on effectiveness of bariatric surgery and identifies the recommendations regarding obesity and bariatric surgery case management programs.
In the primary practice setting disease management companies appear to be spending their time focusing on the general weight loss strategies such as diet and exercise. This is in contrast to larger national healthcare companies who tend to offer bariatric surgical services as a mainstay of treatment to those patients suffering from severe obesity. This means that case management programs within the healthcare systems, insurance companies and health management organizations are often faced with managing patients with severe obesity and, increasingly, these patients are requesting bariatric surgery. So what then is the most effective form of treatment for these individuals? and what should healthcare providers do when faced with these patients?
Research based evidence shows that severe obesity is a disease that is not very responsive to exercise, diet, or drug therapy and that in fact the best results come from those who undergo bariatric surgery. Surgical treatment has been shown to be more effective than drug treatment when it comes to weight loss. This extends to the fact that because bariatric surgery is more effective in providing weight loss it therefore has the greatest benefits for relief of secondary adverse medical conditions that tend to coincide with obesity. The number of Americans having weight loss surgery increased by 804% between 1998 and 2004, this seems to have sparked the recent development of obesity disease management and bariatric surgery case management programs.
Although this is still a very young field of surgery, it is exciting to know that there is an alternative for those who find other weight loss options and methods unachievable to reach their target weight. However bariatric surgery as with any operation is not without its risks and in fact extremely obese patients pose large challenges with regards to anesthesia due to their size and extra stress on their heart and lungs. It will also take them longer to recover post op and put them at higher risk of infection and other such complications as a result of generalized poor health. It is for this reason that there is simply no complete substitute for diet and exercise and in fact many hospitals require a certain amount of weight loss on the patient’s behalf prior to operation to show their commitment to losing weight. Expect to see lots more on this topic in the near future as bariatric surgery becomes more popular and our population as a whole gets more and more obese.