Bariatric surgery to manage excess body weight

Bariatric surgery is the most effective intervention to achieve and maintain a large weight loss (approximately 25 kg). Common procedures are adjustable gastric banding, Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy.

Sleeve gastrectomy was initially used mostly in patients with a BMI more than 50 kg/m², but it is now being used more frequently in patients with lower BMIs.

Compared with other types of bariatric surgery, RYGB results in greater weight loss and greater resolution of glucose abnormalities, but a higher incidence of immediate surgical complications and a higher mortality rate within 30 daysSmith, 2011.

Compared with RYGB, gastric banding results in fewer deaths and shorter hospital stays, but more frequent long-term complications (eg reflux, oesophageal dysmotility, band slippage, band erosion) and greater rates of surgical revision.

Patient selection for bariatric surgery must be rigorous. Surgery is generally not recommended unless the patient has a BMI more than 40 kg/m², or a BMI more than 35 kg/m² with other comorbidities such as diabetes or obstructive sleep apnoea.

Assessment and follow-up with a specialised multidisciplinary team is essential after bariatric surgery. This should include psychological review, as binge eating disorder is common in obese people and may be associated with less postoperative weight loss if not managedMeany, 2014.