Obesity is a chronic disease whose prevalence has reached epidemic proportions worldwide, including North America [1, 7]. It has a significant negative impact on health, leading to the development of numerous comorbidities such as type 2 diabetes mellitus, hypertension, dyslipidemia, sleep disorders, and cardiovascular diseases, including coronary artery disease and heart failure [1, 3, 7]. Weight loss is a key intervention for improving conditions associated with obesity and its related pathologies [3].
In cases of severe obesity where conservative treatment methods prove insufficiently effective, bariatric surgery is recognized as the most potent long-term weight management method [1, 2, 3]. It is associated not only with significant weight loss but also with an improvement in patients' quality of life and remission of many comorbidities [1].
What Is Bariatric Surgery and Who Is It Indicated For?
Bariatric surgery represents a group of surgical interventions aimed at weight reduction in patients with severe obesity [1]. Modern medical guidelines endorse its use for adults with obesity, especially when the body mass index (BMI) reaches high values, as well as in the presence of serious comorbidities [2].
Indications for bariatric surgery include:
- Severe obesity when other treatment methods have not yielded sustained results [1, 2].
- The presence of comorbidities, such as coronary artery disease and heart failure, in severe obesity [3].
The choice of bariatric surgery requires careful patient selection, preoperative optimization of health status, and an individualized approach to procedure selection to minimize risks [3].
Main Types of Bariatric Surgery
There are several primary types of bariatric operations, each with its own features and mechanisms of action [1].
- Laparoscopic Sleeve Gastrectomy (LSG): One of the most common procedures, in which a large portion of the stomach is removed, forming a narrow "sleeve." This leads to a reduction in the volume of food consumed and a decrease in the production of the hormone ghrelin, which is responsible for the sensation of hunger [6].
- Roux-en-Y Gastric Bypass: This surgery creates a small stomach pouch that connects directly to the small intestine, bypassing most of the stomach and duodenum. This limits food intake and alters the hormonal background affecting satiety and metabolism.
In addition to traditional surgical methods, less invasive approaches are also developing:
- Bariatric Arterial Embolization (BAE): This is a minimally invasive endovascular technique aimed at reducing blood flow to the fundus of the stomach. The goal is to suppress ghrelin secretion and regulate appetite. BAE promotes significant short-term weight loss through physiological modulation rather than anatomical alteration. The procedure is well tolerated, and serious complications are rare [4].
- Endoscopic Bariatric Therapy (EBT): These methods are less invasive than surgery, but more effective than diet and lifestyle changes alone [5].
- Intragastric Balloons: Devices temporarily placed in the stomach, occupying its volume and creating a feeling of fullness. For example, Apollo Orbera and ReShape Integrated Dual Balloon System are approved for the treatment of class I and II obesity, including with comorbidities. They have proven their safety and efficacy [5].
- Aspiration Therapy: Involves the placement of a tube that allows patients to empty a portion of the stomach contents after meals. The AspireAssist device is approved for patients with a BMI of 35-55 kg/m2 and has also demonstrated safety and efficacy [5].
Benefits and Outcomes of Bariatric Surgery
Bariatric surgery is the most effective long-term therapy for patients with severe obesity [2]. The main benefits include:
- Significant and Sustained Weight Loss: Patients achieve substantial body weight reduction that is maintained in the long term [1, 4].
- Improved Quality of Life: Weight loss and the resolution of comorbidities significantly enhance overall well-being and quality of life [1].
- Remission of Comorbidities: Bariatric surgery can lead to remission or significant improvement of conditions such as type 2 diabetes mellitus, hypertension, dyslipidemia, and sleep apnea [1, 3]. This is especially important for patients with coronary artery disease and heart failure, where weight loss is a critically important intervention [3].
To enhance outcomes after laparoscopic sleeve gastrectomy (LSG), additional anti-obesity medications (AOMs) may be used during the first year, which can improve weight loss outcomes [6].
Potential Risks and Postoperative Management
Despite its high efficacy, bariatric surgery is a major intervention that can entail new clinical challenges and requires a special diagnostic, preventive, and therapeutic approach [2]. To ensure proper and effective care for patients after bariatric surgery, clinicians need specialized knowledge and skills [2].
Key aspects of postoperative management include:
- Nutrition: Changes in eating behavior and diet are critical. Patients need dietary recommendations to avoid nutrient deficiencies and ensure adequate intake [2].
- Management of Comorbidities: Ongoing monitoring and adjustment of treatment for existing conditions are necessary [2].
- Pregnancy: Women planning pregnancy after bariatric surgery require special recommendations and monitoring [2].
- Psychological Aspects: Patients may face psychological difficulties related to body and lifestyle changes, requiring support [2].
- Prevention and Management of Weight Regain: It is important to develop strategies to prevent weight regain, including lifestyle modifications, diet, and, if necessary, pharmacotherapy [2, 6].
Careful patient selection, preoperative optimization, correct procedure selection, and adequate postoperative management are the key to minimizing risks and achieving the best outcomes [3]. In some cases, referral to subspecialists may be required [2].
Sources
- [1] Review on obesity treatment: bariatric surgery. (BMJ public health, 2024) https://pubmed.ncbi.nlm.nih.gov/41201062/
- [2] Practical recommendations of the Obesity Management Task Force of the European Association for the Study of Obesity for the medical management of patients after bariatric surgery. (Obesity facts, 2017) https://pubmed.ncbi.nlm.nih.gov/29207379/
- [3] Obesity management in patients with coronary artery disease and heart failure. (Heart failure clinics, 2025) https://pubmed.ncbi.nlm.nih.gov/40107803/
- [4] The role of bariatric arterial embolization in the treatment of obesity: a narrative review. (Cureus, 2025) https://pubmed.ncbi.nlm.nih.gov/41426738/
- [5] The role of endoscopic therapy in the treatment of obesity: intragastric balloons and aspiration therapy. (Diabetes, metabolic syndrome and obesity : targets and therapy, 2017) https://pubmed.ncbi.nlm.nih.gov/28740414/
- [6] The use of anti-obesity medications during the first year after laparoscopic sleeve gastrectomy may improve weight loss outcomes. (Obesity surgery, 2025) https://pubmed.ncbi.nlm.nih.gov/40931277/
- [7] Challenges and new directions in obesity treatment: lifestyle intervention programs, pharmacotherapy, and bariatric surgery. (Journal of population therapeutics and clinical pharmacology = Journal de la therapeutique des populations et de la pharmacologie clinique, 2019) https://pubmed.ncbi.nlm.nih.gov/31577079/
Disclaimer: The information presented in this article is for reference purposes only and should not be used for self-diagnosis or self-treatment. Always consult a qualified medical professional for an accurate diagnosis and an individualized treatment plan.