Are bariatric and metabolic surgeries synonymous? – A nutritional view

Abstract

With a significant increase in super (severely)-obese patient populations [ [1] Ng M. Fleming T. Robinson M. Thomson B. Graetz N. Margono C. et al. Global, regional, and national prevalence of overweight and obesity in children and adults during 1980-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2014 Aug 30; 384: 766-781 Abstract Full Text Full Text PDF PubMed Scopus (8050) Google Scholar ], the difficult and often unsuccessful pharmacological and non-pharmacological treatments of the obesity epidemic have favored the spread of surgical options, i.e., bariatric surgery, in the last 30 years [ 2 Bray G.A. Frühbeck G. Ryan D.H. Wilding J.P. Management of obesity. Lancet. 2016 May 7; 387: 1947-1956 Abstract Full Text Full Text PDF PubMed Scopus (509) Google Scholar , 3 Heymsfield S.B. Wadden T.A. Mechanisms, pathophysiology, and management of obesity. N Engl J Med. 2017 Jan 19; 376: 254-266 Crossref PubMed Scopus (764) Google Scholar , 4 Mechanick J.I. Youdim A. Jones D.B. Garvey W.T. Hurley D.L. McMahon M.M. et al. American Association of Clinical EndocrinologistsObesity SocietyAmerican Society for Metabolic & Bariatric SurgeryClinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient–2013 update: cosponsored by American Association of Clinical Endocrinologists, the Obesity Society, and American Society for Metabolic & Bariatric Surgery. Obes (Silver Spring). 2013 Mar; 21: S1-S27 Crossref PubMed Scopus (813) Google Scholar ]. Over these years, several surgical options [ [5] Padwal R. Klarenbach S. Wiebe N. Birch D. Karmali S. Manns B. et al. Bariatric surgery: a systematic review and network meta-analysis of randomized trials. Obes Rev. 2011 Aug; 12: 602-621 Crossref PubMed Scopus (190) Google Scholar ] have been suggested, aiming at obtaining a significant (more than 20%) and stable weight loss and stable control of (metabolic, cardiovascular, respiratory, etc.) complications. Therapeutic objectives are achieved by surgically inducing reduced food intake and/or controlled selective malabsorption of carbohydrates and lipids in particular [ 6 De Luca M. Angrisani L. Himpens J. Busetto L. Scopinaro N. Weiner R. et al. Indications for surgery for obesity and weight-related diseases:position statements from the International Federation for the surgery of obesity and metabolic disorders (IFSO). Obes Surg. 2016 Aug; 26: 1659-1696 Crossref PubMed Scopus (156) Google Scholar , 7 del Genio F. Alfonsi L. Marra M. Finelli C. del Genio G. Rossetti G. et al. Metabolic and nutritional status changes after 10% weight loss in severely obese patients treated with laparoscopic surgery vs integrated medical treatment. Obes Surg. 2007 Dec; 17: 1592-1598 Crossref PubMed Scopus (30) Google Scholar ].