Question

Weight Loss surgery is becoming more and more popular as a treatment method for dangerously obese individuals. Listed below are three examples of individuals who may be a candidate for bariatric surgery.

Would you recommend bariatric surgery to any of these individuals? Make sure you explain why you would or why you wouldn’t recommend surgery for each person.

Person 1: A 75-year-old male, 5’9”, 290 lbs. He has always carried extra weight throughout his life, but in recent years has gained significant amounts of weight. He is diabetic and has a family history of heart disease.

Person 2: A 16-year-old female, 5’3”, 250 lbs. Raised in a family with poor dietary habits, she has been overweight and obese her entire life. Despite many, many failed diet attempts, she continues to gain weight each year.

Person 3: A 45-year-old male, 6’ 1”, 325 lbs. He was a football player in college, but in the years since, all of the muscle mass he used to carry has turned into fat. He is still mobile but isn’t able to do the physical activities he wants to do.

Answer 1

Bariatric Surgery for obesity is considered as last resort. It is done only other strategies like after dieting, exercise, psychotherapy, and drug treatments have failed.

The National Institutes of Health (NIH) guidelines (1991) recommend bariatric surgery in the following conditions:

• Body Mass Index (BMI) > 40 kg/m²
• Or a BMI higher than 35 kg/m² along with high-risk comorbid conditions, such as sleep apnea, pickwickian syndrome, diabetes mellitus, or degenerative joint disease.

Now let us evaluate each of the cases individually.

Person 1: This person's height is 5’9”, 290 lbs. With a BMI of up 42.8. But his age is a cause of concern. Bariatric surgery is usually done in the age group of 16 and 70 years. He is 75 years old and is diabetic. There is history of heart disease too. There is an increased risk of mortality during anesthesia or during the procedure. In the post operative period, it is possible that he might have complications like thrombo-embolism. Thus, his age and presence of co-morbidites make him an unsuitable candidate for bariatric surgery.

Person 2 is a 16-year-old-female. Her BMI is 44.3. Despite many, many failed diet attempts she has not been able to lose weight. Bariatric surgery can be considered in her case.

Person 3 is a 45 year-old-male and has a BMI of 42.9. He is still mobile. Diet modification and exercise should be tried to reduce weight. This can be augmented through pharmacotherapy. If all these fail, then bariatric surgery should be considered for this person. It is not the first choice of treatment.