Which Bariatric Procedure Is Right for Your Patient?

One of your patients is a 30-year-old woman whose BMI is 42. She has been treated for a compulsive eating disorder for the past 10 years, but medications and psychotherapy have not been effective. Another patient is a morbidly obese 52-year-old man who is scheduled to undergo a kidney transplant; however, the operation cannot be performed until he has lost at least 50 lb.

These are among the case scenarios that Sasha Stiles, MD, MPH, discussed in her talk, “Pre and Post Bariatric Surgery.” Dr Stiles is a bariatrician at New York University Medical Center’s Program for Weight Loss Management; she is also board-certified in family medicine.

Bariatric surgery is not a magic solution, said Dr Stiles. Not all patients lose weight; in fact, a few even gain weight after surgery. Obese patients need to learn to rethink their relationship to food.

To teach patients the concept of satiety, Dr Stiles tells them to think of food as filling a fuel tank so that their hunger is sated but they don’t feel “stuffed.” Too many overweight patients eat for psychological reasons and thus use food to fill up their “emotional” tank.

Dr Stiles addressed the pros and cons of 4 types of bariatric procedures:
•Gastric band
•Gastric bypass
•Gastric sleeve
•Duodenal switch

“Generally speaking, the heavier the patient, the more radical the procedure,” she said. The more radical procedures are usually associated with better weight loss results. The gastric band produces slower initial weight loss than the gastric bypass. However, the band has a “built-in insurance policy,” she said, because it can be adjusted. Bypass results in more rapid initial weight loss and is usually best for patients with diabetes.

The patient’s preferences and psychological profile are also important factors in the selection of a bariatric procedure. Dr Stiles said that no procedure is guaranteed to succeed in all patients.