Bariatric surgery (or metabolic surgery or weight loss surgery) is a medical term for surgical procedures used to manage obesity and obesity-related conditions.[1][2] Long term weight loss with bariatric surgery may be achieved through alteration of gut hormones, physical reduction of stomach size, reduction of nutrient absorption, or a combination of these.[2][3]Standard of care procedures include Roux en-Y bypass, sleeve gastrectomy, and biliopancreatic diversion with duodenal switch, from which weight loss is largely achieved by altering gut hormone levels responsible for hunger and satiety, leading to a new hormonal weight set point.[3]
In morbidly obese people, bariatric surgery is the most effective treatment for weight loss and reducing complications.[4][5][6][7][8] A 2021 meta-analysis found that bariatric surgery was associated with reduction in all-cause mortality among obese adults with or without type 2 diabetes.[9] This meta-analysis also found that median life-expectancy was 9.3 years longer for obese adults with diabetes who received bariatric surgery as compared to routine (non-surgical) care, whereas the life expectancy gain was 5.1 years longer for obese adults without diabetes.[9] The risk of death in the period following surgery is less than 1 in 1,000.[10] A 2016 review estimated bariatric surgery could reduce all-cause mortality by 30-50% in obese people.[1] Bariatric surgery may also lower disease risk, including improvement in cardiovascular diseaserisk factors, fatty liver disease, and diabetes management.[11]
As of October 2022,[update] the American Society of Metabolic and Bariatric Surgery and International Federation for the Surgery of Obesity recommended consideration of bariatric surgery for adults meeting two specific criteria: people with a body mass index (BMI) of more than 35 whether or not they have an obesity-associated condition, and people with a BMI of 30–35 who have metabolic syndrome.[11][12] However, these designated BMI ranges do not hold the same meaning in particular populations, such as among Asian individuals, for whom bariatric surgery may be considered when a BMI is more than 27.5.[11] Similarly, the American Academy of Pediatrics recommends bariatric surgery for adolescents 13 and older with a BMI greater than 120% of the 95th percentile for age and sex.[13]
^Zarshenas N, Tapsell LC, Neale EP, Batterham M, Talbot ML (May 2020). "The Relationship Between Bariatric Surgery and Diet Quality: a Systematic Review". Obesity Surgery. 30 (5): 1768–1792. doi:10.1007/s11695-020-04392-9. PMID31940138. S2CID210195296. Bariatric surgery is currently the most effective treatment for morbid obesity.
^Hedjoudje A, Abu Dayyeh BK, Cheskin LJ, Adam A, Neto MG, Badurdeen D, et al. (May 2020). "Efficacy and Safety of Endoscopic Sleeve Gastroplasty: A Systematic Review and Meta-Analysis". Clinical Gastroenterology and Hepatology. 18 (5): 1043–1053.e4. doi:10.1016/j.cgh.2019.08.022. PMID31442601. S2CID201632114.
^ abSyn NL, Cummings DE, Wang LZ, et al. (May 2021). "Association of metabolic-bariatric surgery with long-term survival in adults with and without diabetes: a one-stage meta-analysis of matched cohort and prospective controlled studies with 174 772 participants". Lancet. 397 (10287): 1830–1841. doi:10.1016/S0140-6736(21)00591-2. PMID33965067. S2CID234345414.