Surgical treatment for obesity

Abstract

Background: Bariatric or metabolic surgery is a safe and effective intervention for patients with obesity at higherrisk. In 2019, after the reimbursement in Korea, the number of metabolic surgery cases has rapidly increased. We aimed to introduce the current metabolic surgery concepts.Current Concepts: Patients with a body mass index (BMI) of ≥35 kg/m2 without coexisting medical problems and those with a BMI of ≥30 kg/m2 and ≥1 severe obesity-related complication remediable by weight loss could be considered as the candidates for metabolic surgery. The standardized and effective procedures are adjustable gastric banding, sleeve gastrectomy, Roux-en-Y gastric bypass, and biliopancreatic diversion with duodenal switch. The decision on bariatric procedures should be based on the characteristics of patients considering the effectiveness and anticipated complications.Discussion and Conclusion: Metabolic surgery was shown to induce greater weight loss, better control of comorbidities, such as type 2 diabetes, hypertension, and dyslipidemia, and more significant decrease in death compared to that of the nonsurgical approach. Postoperatively, a comprehensive approach consisting of psychosocial, behavioral, nutritional, and pharmacological aspects should be performed to amplify and maintain the effectiveness of metabolic surgery.