The Challenge of Treating Obesity and Overweight Proceedings of a Workshop (2017) / Chapter Skim
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4 Treating Severe Obesity in Adults
4 Treating Severe Obesity in Adults
Pages 23-30
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From page 23... ...
• Bariatric surgery can produce major weight loss and health benefits in such areas as remission or improvements in type 2 diabetes, hypertension, dyslipidemia, sleep apnea, psychosocial impairment, and functioning, as well as improvements in em ployment status. (Wolfe)
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From page 24... ...
"You constantly have to be watching to see what do you do next." For example, he added, if someone with type 2 diabetes has bariatric surgery, "we will give that patient metformin if we see they are starting to get hungry, or if their weight plateaus at a higher level. We won't force them to take it, but as soon as we see someone starting to have difficulty from their bariatric surgery, we will add a medication." Aronne reported that, according to a retrospective review, people who had Roux-en-Y gastric bypass lost more weight when medication was used (Stanford et al., 2017)
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From page 25... ...
Treating severe obesity requires experienced teams, Aronne asserted, including bariatric surgeons, gastroenterologists, obesity medicine specialists, registered dieticians, psychologists, and support staff. "You need the proverbial village to treat the patient with severe obesity," he said.
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From page 26... ...
Consortium has demonstrated that bariatric surgery can produce major weight loss and health benefits. As an example, he reported that the remission rate for type 2 diabetes following gastric bypass surgery is 62 percent at year 3 (Courcoulas et al., 2013)
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From page 27... ...
However, he said, the available data in this regard are not clear, with some data showing that people with impaired renal function at the time of bariatric surgery experience improvement in their renal function over time. Complications requiring subsequent surgeries, such as intestinal obstruction or marginal ulceration, can occur, Wolfe stated.
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From page 28... ...
"We need more detailed research in order to better characterize the disease risk that the patients face," he argued, "as well as make better predictions of outcomes from intervention." Wolfe also made the interesting point that he routinely counsels patients to be prepared for friends, family, and others to be unkind or have other negative responses to their weight loss. ONE PATIENT'S EXPERIENCE "There has never been a time in my entire life, including after bariatric surgery, where I was not at least overweight," said Nikki Massie, a professional writer, marketer, and online community leader living in Baltimore, Maryland.
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From page 29... ...
I thought that was very important, that link between my primary care physician and my bariatric surgeon." Since Massie's surgery, the practice has added dieticians and a series of classes for preoperative education. Patients can enter a longer postoperative program focused on dietary and behavior changes if they regain weight.
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From page 30... ...
"That, we find, gets people to come back." Wolfe said he and his colleagues provide a packet of information informing primary care providers about what to look for in patients who have undergone bariatric surgery and what should be done if any problems are identified. Many of his patients have to travel great distances, he noted, and people from Alaska or Montana are not going to come back to Portland, Oregon, for all their follow-up visits.
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