{"id":163968,"date":"2024-08-07T17:05:54","date_gmt":"2024-08-07T23:05:54","guid":{"rendered":"https:\/\/tecscience.tec.mx\/en\/?p=163968"},"modified":"2024-12-10T17:05:27","modified_gmt":"2024-12-10T23:05:27","slug":"bariatric-surgery","status":"publish","type":"post","link":"https:\/\/tecscience.tec.mx\/en\/health\/bariatric-surgery\/","title":{"rendered":"What is a Bariatric Surgery and Who Should Consider it?"},"content":{"rendered":"\n<p>On platforms like TikTok, content related to <a href=\"\/en\/health\/medicines-for-obesity\/\" target=\"_blank\" rel=\"noreferrer noopener\">weight loss drugs<\/a> and <a href=\"\/en\/health\/losing-weight\/\" target=\"_blank\" rel=\"noreferrer noopener\">procedures<\/a> has surged, often explained by non-health professionals, which can lead to misinformation. Among the trending topics is <strong>bariatric surgery.<\/strong> But what exactly is it, and who should consider it?<\/p>\n\n\n\n<p><a href=\"https:\/\/www.tecsalud.mx\/directorio-medico\/dr-ricardo-xavier-cuellar-tamez\" target=\"_blank\" rel=\"noreferrer noopener\">Ricardo Cu\u00e9llar Tamez<\/a>, a bariatric surgeon at <a href=\"\/en\/tag\/tecsalud\/\" target=\"_blank\" rel=\"noreferrer noopener\">TecSalud<\/a>, explains in an interview with <strong><em>TecScience<\/em><\/strong> that <strong>bariatric surgeries, such as gastric sleeve and gastric bypass<\/strong>, are statistically proven to be the gold standard for long-term weight loss. However, these procedures are primarily for cases of <a href=\"\/en\/health\/microbiota-and-obesity\/\" target=\"_blank\" rel=\"noreferrer noopener\">obesity<\/a>, particularly grade II and III, which must be evaluated by health experts.<\/p>\n\n\n\n<p>According to the <a href=\"https:\/\/www.who.int\/es\/news-room\/fact-sheets\/detail\/obesity-and-overweight\" target=\"_blank\" rel=\"noreferrer noopener\">World Health Organization<\/a> (WHO), <strong>obesity is defined as excessive fat accumulation <\/strong>that poses health risks, such as type 2 diabetes, heart disease, bone and reproductive health issues, and an increased risk of <a href=\"\/en\/health\/ronald-depinho\/\" target=\"_blank\" rel=\"noreferrer noopener\">certain cancers<\/a>. It also affects quality of life, <a href=\"\/en\/health\/years-of-healthy-life-obesity\/\" target=\"_blank\" rel=\"noreferrer noopener\">impacting sleep<\/a> and mobility.<\/p>\n\n\n\n<p>To determine if we are overweight or obese, one key marker is the <strong>Body Mass Index (BMI)<\/strong>, calculated by dividing our weight by our height squared. For example,<strong> if I am 1.60 meters<\/strong> tall and weigh 55 kilograms (55\/1.60&#215;1.60), <strong>my BMI would be 21.4.<\/strong> If I gain weight to 80 kg, it results in a BMI of 31.2; at 110 kg, it\u2019s 42.9, and at 170 kg, <strong>it rises to 66.4.<\/strong><\/p>\n\n\n\n<p>The WHO classifies a <strong>BMI of 18.5 to 24.9 as normal, 25 to 29.9 as overweight, and obesity into three grades<\/strong>: grade I (BMI 30-34.9), grade II (BMI 35-39.9), and grade III (BMI over 40). Many bariatric experts add<strong> a grade IV for BMIs over 50, known as <a href=\"http:\/\/scielo.sld.cu\/scielo.php?script=sci_arttext&amp;pid=S1561-29532020000300011\" target=\"_blank\" rel=\"noreferrer noopener\">extreme obesity or super obesity<\/a>.<\/strong><\/p>\n\n\n\n<figure class=\"wp-block-embed is-type-video is-provider-youtube wp-block-embed-youtube wp-embed-aspect-16-9 wp-has-aspect-ratio\"><div class=\"wp-block-embed__wrapper\">\n<iframe title=\"\u00bfPor qu\u00e9 algunas enfermedades metab\u00f3licas afectan m\u00e1s a los mexicanos?\" width=\"800\" height=\"450\" src=\"https:\/\/www.youtube.com\/embed\/5FNbrfblCdQ?feature=oembed\" frameborder=\"0\" allow=\"accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share\" referrerpolicy=\"strict-origin-when-cross-origin\" allowfullscreen><\/iframe>\n<\/div><\/figure>\n\n\n\n<h2 class=\"wp-block-heading\">What is Bariatric Surgery and Who is it For?<\/h2>\n\n\n\n<p>Cu\u00e9llar Tamez notes that while BMI alone doesn&#8217;t determine overweight or obesity, it provides a guideline. If your BMI indicates a health risk, it&#8217;s ideal to make lifestyle changes, <strong>consult a nutritionist, and increase physical activity.<\/strong> But what if these adjustments don\u2019t lead to weight loss?<\/p>\n\n\n\n<p>The Mexican Social Security Institute (IMSS) <a href=\"https:\/\/www.imss.gob.mx\/sites\/all\/statics\/guiasclinicas\/051GER.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">guidelines for the surgical treatment of adult obesity<\/a>, updated in 2018, defines <strong>bariatric surgery as a set of surgical procedures<\/strong> indicated primarily when medical treatment (diet, exercise, lifestyle changes, pharmacological treatment, behavioral changes, and psychological support) fails to achieve sustained weight loss.<\/p>\n\n\n\n<p>This is where bariatric surgeons come in. They can assess if you have any <a href=\"https:\/\/youtu.be\/5FNbrfblCdQ?si=w9-6TXNCDUk-vZe-\" target=\"_blank\" rel=\"noreferrer noopener\">metabolic conditions<\/a> hindering weight loss, provide <a href=\"\/en\/health\/ozempic-weight-loss\/\" target=\"_blank\" rel=\"noreferrer noopener\">medications<\/a>, and determine if you are a <strong>candidate for bariatric surgery<\/strong> in certain cases of obesity.<\/p>\n\n\n\n<p>&#8220;Patients need thorough evaluation,&#8221; says Cu\u00e9llar Tamez. &#8220;<strong>Bariatric surgery<\/strong> is recommended starting at <strong>grade II obesity<\/strong> with metabolic diseases. New global standards now even consider grade I obesity, but we must choose the best techniques for each case.&#8221;<\/p>\n\n\n\n<p>For instance, &#8220;gastric sleeve is generally recommended for <strong>grade I or II obesity<\/strong>, while bypass might be needed<strong> for grade III,<\/strong>&#8221; he explains, noting that the best treatment depends on each patient&#8217;s medical history.<\/p>\n\n\n\n<figure class=\"wp-block-embed is-type-rich is-provider-spotify wp-block-embed-spotify wp-embed-aspect-21-9 wp-has-aspect-ratio\"><div class=\"wp-block-embed__wrapper\">\n<iframe title=\"Spotify Embed: Ep. 74 - F\u00e1rmacos para bajar de peso \u00bfcu\u00e1ndo s\u00ed?\" style=\"border-radius: 12px\" width=\"100%\" height=\"152\" frameborder=\"0\" allowfullscreen allow=\"autoplay; clipboard-write; encrypted-media; fullscreen; picture-in-picture\" loading=\"lazy\" src=\"https:\/\/open.spotify.com\/embed\/episode\/490a6yhSPUC2YSZKk0WBoF?si=21c22fd949104986&#038;utm_source=oembed\"><\/iframe>\n<\/div><\/figure>\n\n\n\n<h2 class=\"wp-block-heading\">Common Bariatric Surgeries<\/h2>\n\n\n\n<p>Cu\u00e9llar Tamez mentions that the <strong>gastric sleeve is the most common procedure<\/strong> worldwide, accounting for 70% of bariatric surgeries, recommended for type I and II obesity. <strong>Gastric bypass is indicated<\/strong> for grade III and IV obesity.<\/p>\n\n\n\n<p>The <strong>gastric sleeve procedure<\/strong> reduces stomach size. &#8220;Instead of having the capacity of a football, it\u2019s reduced to the size of a banana, with about 70% of the stomach removed,&#8221; says Cu\u00e9llar.<\/p>\n\n\n\n<p>This surgery is mainly recommended for patients with <strong>grade II obesity and chronic degenerative diseases<\/strong> like hypertension and diabetes. However, the expert adds that &#8220;the standard is changing, and <strong>gastric sleeve can also help grade I obesity patients<\/strong> with conditions like insulin resistance, polycystic ovary syndrome, and metabolic diseases.&#8221;<\/p>\n\n\n\n<p><strong>Gastric bypass<\/strong>, on the other hand, is both restrictive and malabsorptive, reducing stomach size and connecting it to the small intestine. It\u2019s typically for <strong>&#8220;heavier patients with metabolic diseases<\/strong> like diabetes or dyslipidemia (high cholesterol and triglycerides).&#8221;<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Benefits and Risks of Bariatric Surgery<\/h2>\n\n\n\n<p>A June 2024 study in <a href=\"https:\/\/www.nature.com\/articles\/s41366-024-01572-w\" target=\"_blank\" rel=\"noreferrer noopener\"><em>Nature<\/em><\/a> reveals that individuals who <strong>underwent bariatric surgery 15 years ago now experience improved health and mood<\/strong>, and <strong>fewer obesity-related and social interaction issues <\/strong>compared to those who opted for non-surgical treatments.<\/p>\n\n\n\n<p>Another study in the <a href=\"https:\/\/academic.oup.com\/eurheartj\/article\/43\/20\/1955\/6542137\" target=\"_blank\" rel=\"noreferrer noopener\"><em>European Heart Journal<\/em> in 2022<\/a> found that &#8220;<strong>bariatric surgery is associated with reduced cardiovascular<\/strong> mortality and a lower incidence of various cardiovascular diseases in obese patients.&#8221;<\/p>\n\n\n\n<p>Cu\u00e9llar Tamez notes that &#8220;<strong>bariatric surgery improves diabetes cases by 83%,<\/strong> putting it in remission because long-term weight loss <strong>decreases the burden on the pancreas<\/strong>. Even in insulin resistance cases, it can prevent progression to diabetes.&#8221;<\/p>\n\n\n\n<p>For <strong>BMIs over 35<\/strong> (grade II obesity), other comorbidities like hypertension, fatty liver, and sleep apnea also improve, with sleep apnea reducing by up to 90%. <strong>In grade III obesity patients<\/strong>, &#8220;quality of life improves by 95%, and mortality reduces over five years due to lowered <a href=\"https:\/\/www.nature.com\/articles\/s41366-023-01412-3\" target=\"_blank\" rel=\"noreferrer noopener\">cardiovascular risk,<\/a>&#8221; says the specialist.<\/p>\n\n\n\n<p><strong>Regarding risks<\/strong>, Cu\u00e9llar Tamez states that &#8220;bariatric surgery today should be comparable to gallbladder surgery or a cesarean in terms of complication rates, very low, provided it&#8217;s done in a center where it\u2019s routinely performed.&#8221; This ensures experienced bariatric surgeons, nurses, and anesthesiologists handle the procedures.<\/p>\n\n\n\n<p>&#8220;These are <strong>minimally invasive laparoscopic<\/strong> techniques; patients recover in seven days and can walk out as the incisions are small, and recovery is swift,&#8221; explains Cu\u00e9llar.<\/p>\n\n\n\n<p>However, he warns, &#8220;I tell patients it\u2019s not a magic wand. It&#8217;s a powerful tool but not a game. <strong>It requires a commitment<\/strong> to dietary changes, physical activity, and supplementation.&#8221;<\/p>\n\n\n\n<p>This last point is crucial because gastric<strong> bypass patients<\/strong> often face &#8220;malabsorption of certain nutrients, micronutrients, and vitamins like calcium, iron, and vitamin D, necessitating <strong>lifelong supplementation<\/strong>,&#8221; says Cu\u00e9llar.<\/p>\n\n\n\n<p><strong>In gastric sleeve cases<\/strong>, &#8220;there are no issues with vitamin and mineral deficiencies, but all patients are advised <strong>to supplement<\/strong> with iron for at least 3, 4, or 5 years,&#8221; emphasizes the surgeon.<\/p>\n\n\n\n<figure class=\"wp-block-embed is-type-video is-provider-youtube wp-block-embed-youtube wp-embed-aspect-16-9 wp-has-aspect-ratio\"><div class=\"wp-block-embed__wrapper\">\n<iframe title=\"Rompiendo estereotipos sobre la obesidad\" width=\"800\" height=\"450\" src=\"https:\/\/www.youtube.com\/embed\/zxPRtNqYMy8?feature=oembed\" frameborder=\"0\" allow=\"accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share\" referrerpolicy=\"strict-origin-when-cross-origin\" allowfullscreen><\/iframe>\n<\/div><\/figure>\n\n\n\n<h2 class=\"wp-block-heading\">Who Are Bariatric Surgery Specialists?<\/h2>\n\n\n\n<p><strong>Bariatric surgeons<\/strong> specialize in these surgeries, but it\u2019s essential they have a <strong>multidisciplinary team, <\/strong>including a n<strong>utritionist, psychologist, and internist<\/strong>, to provide comprehensive evaluation and follow-up for the patient\u2019s conditions.<\/p>\n\n\n\n<p>Both the nutritionist and psychologist must be experts in<strong> bariatric patient care<\/strong>. Cu\u00e9llar notes that creating a plan for a patient with an average BMI seeking healthier eating or losing a few pounds differs significantly from managing <strong>someone with grade II or III obesity undergoing bariatric surgery.<\/strong><\/p>\n\n\n\n<p>The <strong>psychologist familiar with bariatric cases<\/strong> understands the challenges patients face post-surgery, many of which are positive, but they must be prepared to overcome them, explains the specialist.<\/p>\n\n\n\n<p>This <strong>multidisciplinary team can better assess candidates<\/strong> for surgery and offer alternatives for those who don\u2019t qualify. For example, some patients <strong>need stabilization<\/strong> before surgery due to uncontrolled conditions like diabetes.<\/p>\n\n\n\n<p>&#8220;I tell some patients, &#8216;I need to control your condition before surgery to ensure your safety. If you have uncontrolled diabetes or hypertension, there\u2019s a higher risk.&#8217; That\u2019s why an<strong> internist is part of the team<\/strong> to manage such cases,&#8221; says Cu\u00e9llar.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Is it Difficult to Access Bariatric Surgery in Mexico?<\/h2>\n\n\n\n<p>The answer is yes, but with limitations. Cu\u00e9llar Tamez notes that &#8220;bariatric surgery is <strong>accessible to only 1% of the population because it\u2019s expensive in the private sector,<\/strong> and public health programs are insufficient to cover the need. Therefore, the number of patients we serve is low, although many more could benefit.&#8221;<\/p>\n\n\n\n<p>How many could benefit? In Mexico, <strong>75.2% of the adult population (20 years and older) is overweight or obese<\/strong>, according to the <a href=\"https:\/\/www.insp.mx\/informacion-relevante\/la-salud-de-los-mexicanos-en-cifras-resultados-de-la-ensanut-2022\" target=\"_blank\" rel=\"noreferrer noopener\">National Health and Nutrition Survey<\/a> (Ensanut). These conditions have an <strong>economic impact<\/strong> equivalent to 2.1% of the GDP due to associated chronic diseases&#8217; healthcare costs.<\/p>\n\n\n\n<p>For example, &#8220;<strong>90% of type 2 diabetes cases in the country<\/strong> are attributed to overweight and obesity,&#8221; according to the IMSS <a href=\"https:\/\/www.imss.gob.mx\/sites\/all\/statics\/guiasclinicas\/051GER.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">obesity treatment guide<\/a>. Reducing the BMI of these patients could <strong>decrease comorbidities<\/strong> and healthcare expenses, making bariatric surgery a valuable tool.<\/p>\n\n\n\n<p>In November 2020, the Senate approved changes to the <strong>General Health Law<\/strong>, allowing all public institutions within the National Health System to <strong>integrate bariatric surgery<\/strong> as a treatment for obesity and its comorbidities. However, it\u2019s unclear how many have accessed this service since then.<\/p>\n\n\n\n<p>A 2022 government website <a href=\"https:\/\/www.gob.mx\/salud\/prensa\/545-cirugia-bariatrica-alternativa-de-tratamiento-de-obesidad-secretaria-de-salud\" target=\"_blank\" rel=\"noreferrer noopener\">report<\/a> states that between <strong>100 and 150 bariatric surgeries<\/strong> are performed annually at the Obesity Clinic of the \u201cManuel Gea Gonz\u00e1lez\u201d General Hospital. Still, national data on such procedures in public institutions is scarce.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">What to Consider Before Bariatric Surgery<\/h2>\n\n\n\n<p>If you have access to <strong>these treatments privately,<\/strong> Cu\u00e9llar recommends finding a <strong>reputable surgeon <\/strong>(check their credentials, certifications, and professional experience). &#8220;The most important factor for long-term success is <strong>having a multidisciplinary team<\/strong> supporting you throughout the process, not just during surgery.&#8221;<\/p>\n\n\n\n<p>The expert emphasizes that your surgeon should order <strong>preoperative tests<\/strong> to understand your health status before surgery. &#8220;Some patients undergo surgery with just a basic blood test, which isn\u2019t enough.&#8221;<\/p>\n\n\n\n<p>&#8220;You need evaluations from a psychologist, nutritionist, and the surgeon to see if you are a candidate. I request an <strong>ultrasound, thyroid check, X-ray, and electrocardiogram<\/strong> to ensure complications are less than 1% and mortality is 0%,&#8221; adds Cu\u00e9llar.<\/p>\n\n\n\n<p>It\u2019s crucial that they also explain the <strong>differences between both techniques<\/strong> and help you determine which is best for you: \u201cSome patients come to me saying,<strong> \u2018I want a gastric sleeve,\u2019<\/strong> and I tell them, \u2018You\u2019re not a candidate because you have acid reflux or your BMI isn\u2019t high enough. This surgery is too much for you, and I won\u2019t perform it.\u2019 Instead, I recommend a treatment that is better suited for their health condition and will benefit them more in the long run.\u201d<\/p>\n\n\n\n<figure class=\"wp-block-embed is-type-video is-provider-youtube wp-block-embed-youtube wp-embed-aspect-16-9 wp-has-aspect-ratio\"><div class=\"wp-block-embed__wrapper\">\n<iframe title=\"\u00bfQu\u00e9 soluciones promete la ciencia del futuro para combatir la obesidad infantil?\" width=\"800\" height=\"450\" src=\"https:\/\/www.youtube.com\/embed\/LlMveyHoqk8?feature=oembed\" frameborder=\"0\" allow=\"accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share\" referrerpolicy=\"strict-origin-when-cross-origin\" allowfullscreen><\/iframe>\n<\/div><\/figure>\n\n\n\n<h2 class=\"wp-block-heading\">Which is the Post Bariatric Surgery Care That I Should Follow?<\/h2>\n\n\n\n<p>According to Cu\u00e9llar Tamez, it\u2019s a myth to say that bariatric surgery is <strong>the \u201ceasy way out\u201d<\/strong> because \u201c<strong>patients need to commit, <\/strong>and it\u2019s not simple. You have to start like a baby. The post-bariatric surgery diet involves two weeks of liquids, two weeks of purees, then slowly introducing solids. By three months, the patient is eating solid food, and this process is complex.\u201d<\/p>\n\n\n\n<p>However, the specialist adds: \u201cI tell my patients that they need to be ready for a radical change because we\u2019re starting from scratch. It\u2019s a clean slate, <strong>a new opportunity to do things right.<\/strong> But if you have doubts, it\u2019s better to have the surgery when you\u2019re truly ready because <strong>the changes are amazing<\/strong>, and the more effort the patient puts in, the better the results.\u201d<\/p>\n\n\n\n<p>\u201cBy putting in effort, I mean <strong>sticking to the diet, being more <a href=\"\/en\/health\/benefits-of-exercise\/\" target=\"_blank\" rel=\"noreferrer noopener\">physically active<\/a>,<\/strong> and taking supplements. Those three things. But supplementation isn\u2019t as complicated or expensive as people think. I prescribe a special bariatric multivitamin that\u2019s not very costly\u2014you just take one pill a day, and it lasts for three months,\u201d he notes.<\/p>\n\n\n\n<p>Keep in mind that you\u2019ll need <strong>follow-up for five years<\/strong> because \u201cbariatric surgery <strong>has a honeymoon period<\/strong> \u2014the first two years\u2014 when the patient might take great care and do well, but weight regain can occur. That\u2019s where education comes in. We help them understand better how and what to eat, but it\u2019s also a commitment for them to change their lifestyle and be more physically active,\u201d says the specialist.<\/p>\n\n\n\n<p><strong><em>Did you find this story interesting? Would you like to publish it? Contact our content editor to learn more at\u00a0<a href=\"mailto:marianaleonm@tec.mx\">marianaleonm@tec.mx<\/a>\u00a0<\/em><\/strong><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Gastric sleeve and gastric bypass can improve the long-term health of patients with obesity, but who are candidates for this surgery?<\/p>\n","protected":false},"author":41,"featured_media":163972,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"_eb_attr":"","footnotes":""},"categories":[86],"tags":[224,166,144],"class_list":["post-163968","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-health","tag-health","tag-institute-for-obesity-research","tag-tecsalud"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v21.0 (Yoast SEO v27.4) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>What is a Bariatric Surgery and When 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