Overweight and obesity are major worldwide health problems. Nowadays there is a huge selection of traditional weight loss therapies, such as low-energy diets, different types of exercises, behaviour therapy and modification, pharmacological treatment and other methods.
Unfortunately, clinically severely obese patients respond poorly to traditional diets and exercise and have limited success. Even when an initial response occurs, it is likely to be poorly maintained. While many people achieve some weight loss initially, the majority fails to maintain the reduced body weight in the long run. In these situations gastric bypass surgery is a well-accepted solution and is the mainstay of surgical therapy for the treatment of obesity and, compared to conventional weight loss methods (e.g., diet, exercise), results in considerable and long-term weight loss. Currently, several bariatric surgeries are performed around the world, including vertical banded gastroplasty, gastric banding, sleeve gastrectomy, biliopancreatic diversion, duodenal switch, and Roux-en-Y gastric bypass.
After gastric bypass surgery weight loss is achieved because the size of the stomach is reduced during the surgery. Short-term studies (3 to 5 years) show that a person loses from 40% to 80% of excess weight after bariatric surgery, whereas long-term studies (>10-year follow-up) indicate that loss of excess weight after the surgery varies from 50% to 80%, depending on the surgical technique used.
However, in order to achieve a certain goal surgery alone is not enough. That is why before and after the surgical treatment patients are educated extensively about the surgery, complications, predictions and outcomes. Typically they also undergo counseling with a dietitian and surgeon. They get acquainted with possible psychosocial issues and the required pre-surgical and post-surgical behavioural changes.
The most important and rather difficult change in lifestyle for the majority of patients is dieting. The new gastrointestinal anatomy created by the surgeons is designed to accommodate only small amounts of food. That is why patients must change their meal portion sizes. Also, the new gastrointestinal tract requires some changes in digestion and absorption, that is why meals should be rich in protein, fiber, vitamins, minerals and other nutrients and regular monitoring of iron, vitamin B12 and blood count is recommended.
In addition to the recommendations for dietary changes, exercises should become a routine component in the patients’ lives after surgery. It helps to reduce weight and reduce the risk of coronary heart disease, stroke, type 2 diabetes, hypertension and colon cancer, which are common among obese patients. Moreover, after long-term obesity, the muscles and joints are damaged, that is why physical therapists should instruct, monitor, and educate the patients about the importance of exercise, including mode, frequency, and intensity of activity for cardiovascular fitness, muscle strength, and endurance.
Obese patients usually are depressed because of their inactivity and discrimination. However, after bariatric surgery and weight loss they regain sexual interest, the enjoyment and frequency of it increases. After surgery sexual satisfaction increases, which means that the overall satisfaction with life and the surgery outcome grow.
Obesity is associated with fair or poor health and plenty of diseases. Bariatric surgery has a great impact on these co morbidities. Even a small weight loss improves type 2 diabetes, dyslipidemia, hypertension, joint pain, sleep apnea and leads to an improved long-term control of these same conditions.
Studies show that people use fewer medications to alleviate co morbidities after obesity surgery. For instance, people taking mmedication for diabetes reported a reduction by 72%. Subjects with depression also noted a marked reduction in medication usage by 50%. Medication usage for other obesity-related conditions such as hypertension, hyperlipidemia, and arthritis were also significantly reduced. Such major reduction in medication usage for obesity-related conditions positively impacts the budgets of individuals, insurance companies and other institutions.