Dr Dev Datta, Cardiff and Vale University, UK
What are the clinical issues?
Visceral obesity is a major problem which results in insulin resistance, hypertension, dyslipidaemias, diabetes and increased cardiovascular risk.
- There are very few effective medications available to reduce obesity (orlistat, liraglutide, Mysimba [naltrexone hydrochloride and bupropion hydrochloride]).
- Identifying the right patient for bariatric surgery is difficult and requires a multidisciplinary approach.
- Eating habits are not thoroughly addressed during the work-up for medical/surgical intervention.
What are the implications and answers?
- Prior psychology and the psychological impact of bariatric surgery must be adequately addressed – integrated weight management services are required, but can be costly and resource-intensive.
- Assessment needs to include evaluation of a possible history of childhood trauma or complex social circumstances as these factors adversely influence weight control. These patients may tend to use ‘food’ as emotional regulation.
- Body image is difficult to fix and so while bariatric surgery reduces obesity acutely, subsequent management and support is critical.
- Dietary modification must be introduced before surgery.
- Multiple strategies are needed to deal with obesity effectively.
- Bariatric surgery, commonly using a gastric sleeve, reduces appetite and increases satiety, but must be undertaken in conjunction with lifestyle modification in order to achieve long-term benefit.
- Achieving small improvements in function and weight loss result in a significant improvement in quality of life.
- Selecting the right patient for bariatric surgery requires an integrated multidisciplinary approach assessing psychological background, introducing dietary modification prior to surgery and preparing patients for the altered state post-bariatric surgery.