How Bariatric Surgery WORKS: Learn the success behind surgery and what makes it even more effective

Obesity has become a global health concern, leading to various metabolic complications such as type 2 diabetes, non-alcoholic fatty liver disease (NAFLD), and autoimmune diseases. In recent years, advancements in obesity medicine have shed light on the crucial role of the gastrointestinal (GI) tract in regulating metabolic functions. Bariatric surgery, once primarily used to manipulate the stomach for weight loss, has evolved to be a powerful tool in managing obesity-related conditions and improving overall health.

This blog explores the influence of the GI tract on metabolic function, the impact of bariatric surgery on weight loss and metabolic complications, and the potential of additional anti-obesity medications to enhance results.

The GI tract is not merely responsible for digestion and nutrient absorption; it also plays a pivotal role in regulating hormones and the immune system. Together, these components influence energy function and metabolism. The intricate network of the GI mucosa absorbs nutrients and regulates various hormones and immune responses, which can significantly affect conditions such as diabetes, NAFLD, and autoimmune diseases.

Bariatric Surgery for Metabolic Improvement:

Historically, bariatric surgery focused on manipulating the stomach for weight loss. Modern procedures like vertical sleeve gastrectomy, Roux-en-Y gastric bypass, biliopancreatic diversion, or duodenal switch not only achieve physiological weight loss but have also shown dramatic improvements in type 2 diabetes.

Metabolic Complications and Bariatric Surgery:

Bariatric surgery has demonstrated significant benefits in managing metabolic complications associated with obesity. Studies show improvements in diabetes, hypertension, and a reduced risk of over 15 cancers after surgery. A Veterans group study revealed that patients' comorbidities began to decrease three years after undergoing bariatric surgery.

Mechanisms of Bariatric Surgery:

Older bariatric surgery models primarily focused on mechanical restriction and malabsorption for weight loss. However, modern theories emphasize changes in endocrine and neuronal structures that aid in weight loss. The body fat mass defense model suggests that the body regulates its weight and resists extreme weight loss or gain. Bariatric surgery affects hunger and satiety, with few patients becoming underweight after the procedure studies show.

Challenges and Variability in Bariatric Surgery Outcomes:

Post-surgery, some patients experience dramatic changes in hunger and satiety, leading to weight loss, but the effects may not be sustained in the long term. Studies indicated that after this initial weight loss period after bariatric surgery, weight loss reaches a peak. The body's natural defense mechanisms may kick in, leading to a plateau in weight loss or even weight regain. Additionally, individual responses to surgery can vary, with a minority of patients not achieving significant weight loss or experiencing weight gain.

Combining Bariatric Surgery with Anti-Obesity Medications:

To prevent weight regain or enhance weight loss, lifestyle changes are vital. Traditional calorie reduction may not be effective in the long term. Instead, the addition of anti-obesity medications can be beneficial. Research has shown promising results when adding medications like GLP1 (e.g., liraglutide) to bariatric surgery for diabetic patients, leading to additional weight loss in the majority of cases.

Conclusion:

The GI tract plays a central role in regulating metabolic function, and bariatric surgery has emerged as an effective tool to combat obesity-related complications. By understanding the mechanisms involved and combining surgery with appropriate medications, we can optimize weight loss outcomes and improve metabolic health for patients struggling with obesity. As research in obesity medicine continues to evolve, a more comprehensive approach to obesity management will likely lead to better long-term success for patients.