Bariatric surgery treats severe obesity by altering the digestive system to reduce food intake and nutrient absorption. “Comorbidities” refer to co-occurring health conditions frequently linked with obesity, which bariatric surgery seeks to address. The primary goal extends beyond weight loss, focusing on resolving or ameliorating these associated health issues.
Health Conditions Improved by Bariatric Surgery
Type 2 Diabetes Mellitus often improves or goes into remission, sometimes quickly after surgery, even before significant weight loss. This benefit arises from changes in gut hormones like glucagon-like peptide-1 (GLP-1), improvements in insulin sensitivity, and pancreatic beta-cell function. Procedures like Roux-en-Y gastric bypass (RYGB) and biliopancreatic diversion (BPD) often show higher rates of diabetes remission.
Hypertension commonly improves after bariatric surgery, with many patients reducing or discontinuing medication. This improvement is linked to weight loss, decreased arterial stiffness, and improved insulin resistance. Studies indicate surgical patients are significantly more likely to achieve controlled blood pressure without medication compared to those receiving only medical therapy.
Obstructive Sleep Apnea (OSA) often resolves or greatly reduces in severity following bariatric surgery, with most patients experiencing improvement or resolution of symptoms. This is due to the reduction of fatty tissue around the upper airway, and other weight loss-independent pathways.
Dyslipidemia, characterized by abnormal cholesterol and triglyceride levels, typically shows improvement after bariatric surgery. Specifically, triglyceride levels often decrease, and high-density lipoprotein (HDL) cholesterol levels tend to increase. More consistent reductions are noted in triglycerides and low-density lipoprotein (LDL) cholesterol.
Osteoarthritis can be alleviated as reduced body weight lessens the mechanical load on weight-bearing joints like knees and hips. For every pound of weight lost, pressure on the knee joint can decrease by approximately four pounds. Beyond mechanical relief, bariatric surgery also helps reduce systemic inflammation, which contributes to cartilage breakdown and joint pain.
Non-Alcoholic Fatty Liver Disease (NAFLD), including Non-Alcoholic Steatohepatitis (NASH), can show significant improvement or even reversal after bariatric surgery. This is due to weight loss, which reduces fat accumulation, inflammation, and fibrosis in the liver. Gastric bypass, in particular, has demonstrated notable improvements in liver steatosis and fibrosis.
Gastroesophageal Reflux Disease (GERD) can be alleviated by bariatric surgery, particularly with Roux-en-Y gastric bypass (RYGB). RYGB has shown similar effectiveness to other anti-reflux surgeries in reducing heartburn and medication needs. However, some other bariatric procedures, such as laparoscopic sleeve gastrectomy, may sometimes increase or worsen GERD due to altered stomach pressure.
Potential New or Worsened Conditions After Bariatric Surgery
Nutritional deficiencies are common, especially after malabsorptive procedures, due to altered digestion and reduced absorption. Common deficiencies include iron, vitamin B12, calcium, and vitamin D, necessitating lifelong supplementation. Iron deficiency can lead to anemia, and vitamin B12 deficiency can cause neurological symptoms.
Dumping syndrome is frequent, particularly after Roux-en-Y gastric bypass, when food moves too quickly into the small intestine. Early dumping (10-30 minutes after eating) can cause bloating, nausea, sweating, abdominal cramps, and diarrhea. Late dumping (1-3 hours post-meal) results from a rapid drop in blood sugar and causes sweating, tremors, confusion, or fainting. Foods high in sugar or fat are common triggers.
Gallstones are an increased risk after bariatric surgery, affecting about 10-38% of patients, often within the first two years. Rapid weight loss causes the liver to release more cholesterol into bile, and the gallbladder may empty less frequently, facilitating stone formation. Ursodeoxycholic acid (UDCA) is often prescribed preventatively to dissolve cholesterol in bile.
Mental health impacts can include new or worsened depression, anxiety, or substance abuse issues. While many patients experience improved mental well-being, some may face dissatisfaction due to unmet weight loss expectations or body image concerns. There is also an increased risk of self-harm and alcohol use disorder in some patients post-surgery.
Gastrointestinal complications, though less common, can arise. These include strictures, which are narrowings at surgical connections, often treated endoscopically. Ulcers, particularly marginal ulcers near the surgical join, can cause pain, nausea, or bleeding. Internal hernias and bowel obstructions may occur when a section of the intestine becomes trapped, characterized by abdominal pain and vomiting.
Excess skin is a common physical consequence, influenced by genetics and age. While not a medical comorbidity, it can cause discomfort, hygiene issues, and affect body image. Surgical removal of excess skin, known as body contouring, is an option usually considered 18 months post-surgery after weight has stabilized.
Managing Health Post-Surgery
Managing health after bariatric surgery involves a lifelong commitment to new habits and ongoing support. Lifelong follow-up care with a multidisciplinary team, including the surgeon, dietitian, and psychologist, is recommended. Regular appointments, especially more intensive monitoring during the first year, are important for addressing potential issues and ensuring long-term success.
Dietary adherence is important for post-surgical management. Patients must follow specific eating plans, prioritizing protein intake, typically 60-100 grams per day, to preserve muscle mass and support healing. Adequate hydration is also important, with a daily fluid goal of 64 ounces or more, consumed by sipping slowly throughout the day, avoiding carbonated or sugary drinks.
Vitamin and mineral supplementation is mandatory for life to prevent deficiencies. A complete multivitamin, along with additional calcium, vitamin D, and iron, are commonly prescribed. These supplements compensate for reduced food intake and altered nutrient absorption in the modified digestive tract.
Physical activity plays a significant role in maintaining weight loss and improving overall health. Gentle walking can begin soon after surgery, with a gradual increase in intensity and duration. Incorporating strength training helps build muscle mass, which aids in metabolism and can improve the appearance of excess skin.
Mental and emotional support is equally important throughout the bariatric journey. Patients benefit from therapy, support groups, and a strong personal network to navigate emotional changes, body image issues, and develop healthy coping mechanisms. Addressing emotional eating and setting realistic expectations contributes to long-term psychological well-being.