22 Questions
What is the typical weight loss for obese people through dieting, exercise, and lifestyle intervention?
6-8% body weight
Why do most people regain weight after dieting?
Due to decrease in basal metabolic rate
What is the estimated weight loss maintenance rate for bariatric surgery?
15-25% up to 20 years
What is the term used to describe the effects of bariatric surgery on diabetes and metabolic syndrome?
Metabolic surgery
What is the primary benefit of bariatric surgery?
Long-term survival benefit and improvement in quality of life
What is a benefit of surgery for people with severe obesity?
Medications can be reduced or stopped as glycaemic control improves
What is the primary goal of bariatric surgery?
To reset the homeostatic set point
According to NICE, who should be considered for bariatric surgery?
People with severe obesity who have tried non-surgical measures
What is the estimated duration of weight loss maintenance for bariatric surgery?
Up to 20 years
What percentage of people fulfilling the eligibility criteria are estimated to have no medical or psychological reason not to have surgery?
80%
What is included in the term 'metabolic syndrome'?
Type 2 diabetes, high blood pressure, dyslipidaemia, and polycystic ovary syndrome
What is the estimated percentage of people who might want bariatric surgery?
10%
What is important for achieving improved outcomes in bariatric surgery?
A multidisciplinary team of healthcare professionals
What is the main cause of death after bariatric surgery?
DVT/PE
How long is appropriate prophylaxis usually used for after bariatric surgery?
At least 1 week
What is important for biochemical guidance after bariatric surgery?
Regular blood tests
What is included in the baseline blood tests for patients?
Full blood count, urea and electrolytes, liver function tests, thyroid function tests, ferritin, folate, vitamin D, Ca++, parathyroid hormone plus HbA1c, fasting glucose, lipid profile
What is the frequency of full blood count, urea and electrolytes, and HbA1c tests after gastric banding?
Annually
What additional tests are required after gastric bypass, sleeve gastrectomy, or BPD/DS compared to gastric banding?
Liver function tests, ferritin, folate, vitamin D, Ca++, and parathyroid hormone tests
What is the recommended frequency for vitamin B12 tests after gastric bypass, sleeve gastrectomy, or BPD/DS?
Every 6 months, then annually
What is the likely cause of the patient's presentation with polyneuropathy and severe paraesthesia after a gastric bypass?
Vitamin B12 deficiency
What is the recommended test for a patient presenting with steatorrhoea?
Vitamin A test
Study Notes
Understanding Severe and Complex Obesity
- Obesity is becoming a major health issue in the 21st century
- Dieting and lifestyle interventions can lead to 6-8% weight loss in the short term, but most people regain weight due to a decrease in basal metabolic rate
Rationale for Bariatric Surgery
- Bariatric surgery can alter the body's homeostatic set point, leading to 15-25% weight loss maintenance up to 20 years
- Surgery leads to long-term survival benefits, improves obesity-related diseases, and enhances quality of life
Metabolic Surgery
- Metabolic surgery can improve type 2 diabetes, high blood pressure, dyslipidaemia, and polycystic ovary syndrome
- Surgery can have a greater impact on metabolic syndrome than weight loss itself
Eligibility for Bariatric Surgery
- NICE recommends considering bariatric surgery for people with severe obesity who have tried non-surgical measures with no adequate weight loss
- Patients with shorter duration of type 2 diabetes have a higher rate of remission or improvement
Multidisciplinary Assessment
- Patients should be assessed and managed by a multidisciplinary team of healthcare professionals with varied backgrounds and expertise
- High-volume, specialized units tend to achieve improved outcomes
Complications and Perioperative Care
- The main cause of death after surgery is now DVT/PE, and prophylaxis is usually used for at least 1 week
- Appropriate management is necessary for post-surgical complications
Follow-up and Nutritional Supplements
- Blood tests should be performed at baseline and regularly after surgery to monitor nutritional deficiencies
- Specific tests and supplements are recommended after different types of bariatric surgery
Learn about bariatric surgery, including its rationale, eligibility, and common operations, as well as how to manage perioperative complications and follow-up care. Understand the concept of metabolic surgery and its role in treating obesity.
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