The United States of America has experienced a steady rise in obesity prevalence over the last 20 years and currently ranks second in the world. At the turn of the millennium, nearly two-thirds of Americans were overweight or obese, and almost 5% were morbidly obese. This trend is ominous, because morbid obesity predisposes patients to comorbid diseases which affect nearly every organ system.
These include: type 2 diabetes, cardiovascular disease, hypertension, hyperlipidemia, hypoventilation syndrome, asthma, sleep apnea, stroke, pseudotumor cerebri, arthritis, several types of cancers, urinary incontinence, gallbladder disease, and depression. Obesity shortens life expectancy , with increasing body mass index (BMI) resulting in proportionally shorter lifespan. With over 300,000 victims in the USA each year, morbid obesity is projected to overtake smoking as the leading cause of death in the near future.
Preparing for Surgery
The preoperative evaluation is similar for all bariatric procedures. The components include determining a patient’s indications for surgery, identifying issues which may interfere with the success of the surgery, and assessing and treating comorbid diseases. Typical assessment includes psychological testing, nutrition evaluation, and medical assessment.
Many insurance companies require such psychological evaluation prior to granting precertification for a bariatric procedure.
The nutrition professional is an integral part of multidisciplinary bariatric care. The patient will be under the direct supervision of a weight loss doctor, or a Registered Dietician who specializes in weight loss patients. After the initial evaluation, follow up is on a regular basis and continues well after surgery.
Medical assessment is made prior to bariatric surgery. A Thorough history and physical examination with systematic review is used to identify comorbidities. If a consultation with a medical subspecialist is necessary, we will help to facilitate.
Although your doctor will determine what may be necessary for you, commonly, routine laboratory evaluation is performed and will typically include complete blood count, metabolic profile, coagulation profile, lipid profile, thyroid function tests, and ferritin. Vitamin B12, and fat-soluble vitamin levels may be evaluated if considering a malabsorptive procedure. Cardiovascular evaluation includes electrocardiogram and possible stress test to identify occult coronary artery disease. Respiratory evaluation may include chest X-ray, arterial blood gas, and pulmonary function tests. Sleep apnea may be diagnosed by sleep study and the patient started on continuous positive airway pressure prior to surgery. Upper endoscopy may be used if suspicion of gastric pathology exists. If H. pylori infection is present, preoperative therapy is advised. The liver may be assessed by hepatic profile and ultrasound. In cases of suspected cirrhosis, biopsy may be indicated. Ultrasound may be used to detect gallstones, allowing the surgeon to decide on concomitant cholecystectomy.