Real life issues & answers: The overweight patient

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.

Key messages

  • 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.