A Bariatric Primer ...
What is Bariatric Surgery?
Bariatric surgery is a field of medicine devoted to the treatment of morbid obesity – including medical, surgical, psychological, dietary, exercise physiological, and lifelong support to detect and treat remission. Current standards for bariatric surgical practice are evolving, and new recommendations are that surgeons devoting > 75% of their practice to this field should provide such care. Fellowships in bariatric surgery now exist and will influence future standards. Bariatric operations include:

  • Restrictive procedures that reduce the amount of food that can be eaten (vertical banded gastroplasty, laparoscopic adjustable gastric banding)
  • Malabsorptive procedures that reduce the volume of small bowel mucosa exposed to nutrients by rerouting or shortening where food flows (biliopancreatic diversion/duodenal switch)
  • Combined procedures incorporating elements of each (Roux en Y gastrojejunal bypass)

    • Who is a candidate for Bariatric Surgery?
    People who are more than 100 pounds over their ideal body weight are generally good candidates for surgery. Body mass index (BMI) is used to classify levels of obesity, and BMI > 40 is another measure used to determine candidacy. Lower levels of obesity (BMI 35-39.9) with comorbid diseases (see below) may also designate an individual as being able to benefit from surgery. Patients must be able to:

  • Comprehend dietary, medication, behavioral, and exercise instructions
  • Commit to lifelong behavior change and followup with the Bariatric Center
  • Be free of active drug use, alcoholism, self-injurious behavior, anorexia, bulimia, defiant or oppositional personality disorders, schizophrenia, or significant medication noncompliance.

    • Why is Bariatric Surgery performed?
    Untreated morbid obesity can result in a cascade of associated “comorbid” disease states that cause disability, social isolation, extensive medical care, nonemployment, and ultimately reduced lifespan. An abbreviated list would include:

  • Endocrine: Metabolic syndrome, hyperlipidemia, diabetes, polycystic ovarian syndrome, infertility
  • Neoplasia: Cancers of breast, colon, prostate, gallbladder – and worsened prognosis>
  • Respiratory: Obstructive sleep apnea, hypoventilation, asthma
  • Cardiovascular: Premature coronary artery disease, biventricular heart failure, deep venous thrombosis, pulmonary embolism, atherosclerosis, venous stasis and ulcers
  • GI: Gallstones, GERD, nonalcholic steatohepatitis (NASH) with possible liver failure, diarrhea
  • GU: Urinary stress incontinence, infertility, pregnancy complications, prostatic hypertrophy
  • Musculoskeletal: Diffuse symmetrical arthralgias, osteoarthritis, intervertebral disc herniation, chronic low back pain, poor exercise tolerance, myalgias


    • There is no long-term effective dietary, pharmacologic, or behavioral therapy for morbid obesity. Less than 1% of patients can sustain a weight loss of more than 20% of their excess weight at 5 years with these methods. Surgery provides 35-90% excess weight loss at 5 years, depending on operation and compliance. This degree of weight loss can improve or eliminate the majority of these diseases.

    Where can I send my patient for a consultation about Bariatric Surgery?
    We provide group introductory education classes twice a month at Abbott Northwestern Hospital. This 3-4 hour session informs patients about the ideas above, sets expectations, and introduces them to staff members. We help them navigate the common problems experienced by patients who may seek surgery to improve their health. They are educated that this is NOT cosmetic surgery, and will NOT magically cure their life problems. After this, the patient may schedule a consultation with one of our surgeons. Feel free to contact us if you have any questions, or need to speak with one of our surgeons about a patient.