Bariatric and Metabolic Surgery

Obesity is a complex condition, one with serious social and psychological dimensions, that affects virtually all age and socioeconomic groups. It is a consequence of abundance, convenience and underlying biology. Preventing obesity requires changes in the environment and organisational behaviour, as well as changes in groups, family and individual behaviour. Treatment strategies vary in different centres and treatment sectors. Non-surgical management consists of diet, exercise, psychology and pharmacology. Non-surgical management can achieve weight loss. Anti-obesity drugs may be effective as adjunctive therapy to diet and physical activity in those subjects who struggle to lose weight despite following an appropriate weight loss programme. The problem with non-surgical treatment is of long-term sustainability. Bariatric surgery is the only management, which has long-term sustainability of weight loss and reversal of comorbidities. However, it is not applicable to all obese patients. Both restrictive and malabsorptive procedures have a relatively high success rate in weight loss and improvement of blood sugar control. However, these procedures have many pitfalls and complications. Experienced bariatric surgeons in high-volume centres have achieved minimal morbidity and mortality after weight loss surgery. Patient selection and preparation is key to success. Special anaesthetic considerations and modifications must be adhered to. The choice of procedure for any individual patient is a complex process and depends on many factors. Follow-up after bariatric surgery must be rigorous to monitor and correct micronutrient deficiency and provide psychological support to patients who have had to change their life style albeit to a healthier existence.

Keywords: Audit of outcomes, Bariatric surgery, Complications, Diabetes, Diet, Exercise, Medical management, Obesity, Psychology, Re-do bariatric surgery.