Chapter 34 - The role of bariatric surgery in the management of metabolic syndrome

Abstract

Metabolic syndrome is a cluster of interconnected risk factors that significantly raise the incidence of cardiovascular diseases, type 2 diabetes, and mortality rates. With the escalating global prevalence of obesity, the importance of finding effective treatments for metabolic syndrome has become a public health priority. Bariatric surgery has emerged as a promising intervention, not only for sustainable weight loss but also for reducing the burden of metabolic syndrome. This comprehensive review aims to explore the role of bariatric surgery in the management of metabolic syndrome. The review begins by defining metabolic syndrome and highlighting its associated risk factors, such as obesity, dyslipidemia, hypertension, and insulin resistance. It then explores the potential mechanisms by which bariatric surgery exerts its favorable metabolic effects. Various types of bariatric procedures, including Roux-en-Y gastric bypass, sleeve gastrectomy, and adjustable gastric banding, are discussed in terms of their impact on metabolic syndrome. Evidence from numerous randomized controlled trials, cohort studies, and meta-analyses suggests that bariatric surgery not only leads to significant and sustained weight loss but also improves insulin sensitivity, glycemic control, blood pressure, and lipid profiles. Moreover, it has been shown to reduce the incidence of microvascular and macrovascular complications associated with metabolic syndrome. Furthermore, this review addresses the potential risks and complications of bariatric surgery, considering patient selection criteria, surgical technique, and long-term follow-up. The role of postoperative lifestyle modifications, such as dietary changes and physical activity, in optimizing outcomes following bariatric surgery is also emphasized. In conclusion, bariatric surgery is emerging as an effective and viable option for individuals with metabolic syndrome, particularly those with severe obesity. Its metabolic benefits extend beyond weight loss to encompass improvements in insulin resistance, dyslipidemia, hypertension, and overall cardiovascular risk. However, further research is warranted to refine patient selection criteria, optimize surgical techniques, and evaluate long-term outcomes. A multidisciplinary approach involving healthcare professionals, including bariatric surgeons, endocrinologists, and dietitians, is fundamental to provide comprehensive care in the management of metabolic syndrome.