Bariatric surgery, from the Greek baros for weight and also known as weight loss surgery, is the branch of surgical science that deals with treating patients suffering from obesity.
It has been shown that bariatric surgery is the only treatment that can lead to long-term significant weight loss, by considerably reducing the risk of mortality and of developing new obesity-related diseases. Bariatric surgery is recommended for patients who meet certain elective criteria:
- Lack of or unsatisfactory response to other therapeutic approaches (personalized diet, physical activity, pharmacological therapy, and so on);
- A BMI of between 35 and 39.9 kg/m² associated with one or more obesity-related diseases (diabetes mellitus types 2, dyslipidaemia, cardiovascular disease, sleep disorders, and so on);
- A BMI of 40 kg/m² or higher.
The advantages of bariatric surgery
Bariatric surgery is the only curative treatment for the severe and the super obese.
The ability to keep long-term body weight within a 19-25 BMI value range is associated with the disappearance of many obesity-related diseases.
The most recent and up-to-date studies and their quite extended follow up on a surgically treated group have shown a significant reduction in mortality rate, in the risk of developing other obesity-related pathologies and the consequent need for further therapeutic treatments.
In fact, the data available inform us that bariatric surgery is able to treat type II diabetes in 80 to 98% of the cases; alcoholic steatosis in 90% and metabolic syndrome in 80%, thus confirming the effectiveness of surgical treatment.
Bariatric surgery: how is it done?
Bariatric surgery is performed under general anaesthesia.
Most operations are conducted in laparoscopy which is lesser invasive technique than laparotomy. When performing a laparoscopy, the surgeon uses special tools and a tiny video camera to obtain images of the area of interest, both of which have been inserted into the patient's abdomen through small holes. The choice of the type of surgery depends on the patient's medical condition.
There are three types of bariatric surgeries:
They involve reducing the gastric capacity. This results in a sense of satiety with fewer calories introduced (gastric bandage, sleeve gastrectomy).
They modify the anatomy of the stomach and of the bowel with a considerable decrease of the absorbing surface (biliopancreatic diversion).
These associate gastric volume reductions with decreased absorption capacity (gastric by-pass).
What is nutritional supplement for bariatric surgery?
Although over-nourished, in most cases obese patients present nutritional deficiencies, many times even before they undergo bariatric surgery.
Obesity is a multifactorial condition due, for example, to the high consumption of nutritionally poor foods (junk food) and to increased adiposity that may adversely affect the storage of certain nutrients.
Moreover, to date, it is known that the anatomical changes generated by surgery and responsible for weight loss alter the normal processes of how nutrients are absorbed from food sources, and thus facilitate the development of nutritional deficits and exacerbate pre-existing ones.
In the post-operation phase, patients may develop macronutrients deficiency, proteins in particular, due to the development of a transient intolerance to high protein foods as well as to the restrictive diet that characterizes this phase, during which it is generally recommended to add protein supplements to micronutrients supplements.
In the long term, it is best that a healthy and balanced diet always include supplements and foods for special medical purposes, that have been adequately formulated to quantitatively and qualitatively meet the body's nutritional needs, as the patient's medical condition requires.
Italian guidelines define “as life-long indispensable” the intake vitamins that may be able to cope with deficiencies. In this case, it is advisable to use a vitamin complex, whose nutrients are separated in hydro and fat-soluble to make its absorption complete, by preventing its components from interacting.
In cases involving gastric resection, due to the lesser production of intrinsic factor which is involved in Vitamin B12 absorption, it is appropriate to integrate the B12 in sublingual form. By bypassing the stomach and reaching the bloodstream directly, the sublingual form improves both the efficacy and the bioavailability of the product.
Furthermore, surgical procedures may alter the iron absorption capacity: this is why patients should integrate throughout their life the daily amount of iron, using compounds that are absorbed even in case of duodenum resection, such as encapsulated micro iron which is absorbed through the lipid metabolism pathway and not through the stomach.
Improper feeding and surgical restructuring can cause disbiotic processes in the patient; in such case, it is advisable to use a nucleotide-based probiotic and Bacillus clausii, the only bacterial strain able to promote the intestinal balance through the heterogeneous proliferation of microbiota and not of single strains.
In cases of constipation, which is linked for example to calcium intake, it is advisable to use liquid fibers with a low glycemic index, non-gelling. These favor the intestinal transit without causing swelling nor inhibiting the absorption of either drugs or other nutrients. A correct nutritional management is fundamental in order to restore the body's welfare and allow adequate weight loss. It is therefore advisable to always follow the indications given by the nutritionist.