Bariatric Surgery: Opportunities and Obstacles

By Steve Barrett
Wednesday, November 1, 2017

Faced with a daunting rise in diabetes and obesity, bariatric surgeons are extending a lifeline to many patients.

The Great Divide

Most men and women who undergo bariatric surgery are interested in follow-up body-contouring surgery to remove excess skin and head off potential skin infections and related conditions. However, few actually undergo such procedures, largely because of insurance and income issues.

Female bariatric patients interested in body-contouring surgery: 75%

Male bariatric patients interested in body-contouring surgery: 68%

Bariatric patients who undergo body-contouring surgery: 6%

Diabetes Worldwide

Diabetes is taking an ever-higher global toll.

The 422 million people who had diabetes in 2014 represent a nearly fourfold increase since 1980.

Nearly half of the people who die for reasons related to high blood glucose fail to reach age 70.

Once viewed almost entirely as an affliction of wealthy countries, diabetes now has a significant impact in low- and middle-income nations.

Diabetes may be the seventh-leading cause of death globally by 2030.

In the United States, diabetes is the direct cause of well over 1 million deaths annually.

A Back Seat for BMI?

BMI is less accurate than waist-to-height ratio in determining obesity risk. In a study, waist-to-height ratio outperformed BMI, waist circumference and other measures in predicting whole-body fat percentage and visceral adipose tissue, which are linked to Type 2 diabetes and cardiovascular disease.

A Note of Caution

More than 20% of nearly 1,500 patients who underwent Roux-en-Y gastric bypass had symptoms of alcohol use disorder within five years after the surgery, according to a study in Surgery for Obesity and Related Diseases. The figure was about 11% for patients who underwent gastric banding.

Researchers say this makes it vital for physicians to regularly ask patients who have undergone bariatric surgery about their use of alcohol. In addition, the American Society for Metabolic and Bariatric Surgery says patients should be alerted to this risk prior to surgery.