Innovations in Weight Loss Management - Episode 6

Concerns and complications of weight loss surgery

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What healthcare professionals should consider prior to recommending weight loss surgery to eligible patients.

Chris Mazzolini: Let’s go through some of the different medical options. Let’s start with weight loss surgery. Dr. Christofides, what are some of the concerns and complications with weight loss surgery? What are some of the factors that go into the decision-making process around weight loss surgery?

Elena A. Christofides, M.D., FACE: Weight loss surgery is a big deal because it’s surgery. You’re going under anesthesia. You’re going under the knife. You’re physically altering the structure of your body. The concern is making sure that the patient has the mental ability to handle that change. Psychiatric evaluations and psychological counseling is required before people undergo device surgery or medical surgery because of issues with the restructuring of the body. You have to make sure that the patient will be able to maintain the lifestyle requirements that are permanently in place now: in alterations of how they permanently eat and drink because of the alterations of the structure of their body. So there’s a lot of counseling that goes into preparing them for weight loss surgery. There’s also the costs alone of the surgery. Who’s going to pay for it? Is it the patient paying, or is it an insurance payment issue? Who’s going to bear that cost? Also, you should recognize that you may get success with reducing the fat mass, but there’s often a lot of rebound involved, postoperatively. There’s a lot of burden, societally speaking, for that patient based on how they interact with their colleagues, coworkers and family because of the changes to their lifestyle. Realistically, the psychological aspect of the counseling pre-operation is as important as ensuring that the patient is making the right decision medically, because they haven’t had as much success as they would’ve liked with diet, exercise or medications.

Chris Mazzolini: Dr. Bays, is there anything you’d like to add about weight loss surgery? Are there any other factors that you think are important to mention?

Harold Edward Bays, M.D., FOMA, FTOS, FACC, FNLA, FASPC: Yes. I think bariatric surgery has come a long way from back in the days when people were performing some of the earlier procedures that involved rather dramatic surgical approaches. Many of the surgeries nowadays are laparoscopic and the success rates are pretty good. The thing that I would like to emphasize is the fact that, if you look at post-surgical data with regards to some of the more common bariatric procedures that are performed now — sleeve gastrectomy and gastric bypassing — some really impressive improvements, such as metabolic profile of the patient as well as reduction in cardiovascular disease outcomes, have been made. If you look at the risk-benefit ratio [RBR], I think in many cases, it looks pretty good. As I said, you can take one example, the diabetes mellitus. I’m not one of those doctors that is enamored by the word ‘cure’ when it comes to bariatric surgery and diabetes mellitus. I prefer the word ‘remission’ because I think there’s a difference. I don’t know if something you do is going to cure you of your underlying physiology, but certainly, there’s good data that a substantial number of patients will go into remission, with regard to their diabetes mellitus, after bariatric surgery. As I mentioned, the cardiovascular disease outcomes data looks good with some of these procedures. I agree that consideration of patients for bariatric surgery should be a thoughtful, careful process and the procedure that you choose should be based upon science. This is a personal opinion. I’m giving a personal opinion. I think there are too many people out there that are still doing lap-band surgery procedures when we have other procedures that have a better data with regard to outcomes, benefits and such. But I guess, because some medical professionals have always done lap-band surgeries, they continue to do it, and I’m not sure that’s the right direction. I completely agree that patients considering bariatric surgery should undergo a thorough, informed consent process that includes a discussion of the various treatment options of the types of bariatric surgeries that are performed.

Chris Mazzolini: Great. Thank you both for that interesting discussion.

Transcript edited for clarity.