Bariatric surgery is the most effective solution to fight obesity in our population, a disease which has had an epidemic growth. This threatening fact has been well documented through the media. It is estimated that in Europe alone there are about 160,000,000 obese patients, where around 1,500,000 are children, reigning in discrimination and where self-esteem is at a very low level, leading to a lack of social fulfillment. In a large part of these patients, both blood pressure and diabetes are altered, as well as other diseases that accompany them, so that more and more family physicians as well as surgeons are subject to greater pressure in an attempt to fight this problem, either non-surgically or surgically, by patients looking for a long and effective weight loss.
Surgical intervention is arguably the most effective and long-lasting treatment of morbid obesity. Bariatric surgery represents a unique discipline for several reasons, the first of which is that bariatric surgery is based on the attempt to change behaviors, as well as physiology, instead of the other reconstructive or resection surgeries. In addition, its success is dependent on the patient’s educational capacity and adherence to the behavioral changes that the surgery imposes. Patients with morbid obesity often have multiple diagnoses because this is a condition that affects almost every system in the body. Surgeons who treat this pathology quickly concluded that it is impossible to carry out this treatment without being through a comprehensive and multidisciplinary program, developed by a diverse and dedicated group of people in the health area, who can evaluate patients, as well as prepare them either mentally or physically for surgery and lifestyle changes that will be asked of them. To this end, there is a need to organize comprehensive programs that require a multidisciplinary approach and a large institutional commitment, leading to the formation of obesity treatment units or bariatric units, capable of having an educational role and developing support strategies for patients.
Patients with a BMI>= 40, or 35 with comorbidities are generally eligible for surgery. Various weight loss attempts must have been made in the past, supervised with diet, exercise or medication. However, we will have to think that some patients with a BMI < 35 may be candidates, but they should be discussed by the whole team.
Although the age between 18 and 60 years is preferable for a surgical treatment, studies show that patients under 18 and above 60 years, after being properly analyzed, may be candidates for surgery. Therefore, age alone is not an objection to surgery.
After surgery, a close follow-up and a multidisciplinary approach are necessary for the success of such a program. The knowledge by the family physicians of the program, the understanding of what bariatric surgery means, how it is performed and what is expected of it is fundamental for these programs to be successful, as they will always be the first to assist the patient and say or give them what they need.
The surgeries currently being performed can be of various types and performed in several ways.