Metabolic & Bariatric Surgery
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Definition of morbid (aka, clinically severe) obesity is:
- 100lbs over ideal body weight
- twice ideal body weight
- or BMI of 40kg/m2 or greater
What is ghrelin?
Where is it produced?
What does it do?
a 28-amino acid orexigenic peptide hormone
- predominantly secreted by the oxyntic glands of the proximal part of the stomach
- also produced to a lesser extent by the bowel, pancreas, and hypothalamus
causes release of growth hormone and increases the insulin signaling mechanism
What influences ghrelin levels?
Ghrelin increased by weight loss & caloric restriction
Ghrelin decreased after gastric bypass
Diet for medical management of morbid obesity =
very-low-calorie, restriction of fat or carbohydrate intake
Pharmacologic therapy for morbid obesity:
Sibutramine - blocks the presynaptic uptake of norepinephrine & serotonin thereby potentiating their anorexic effect in the CNS
Orlistat - inhibits pancreatic lipase thereby reducing the absorption of up to 30% of ingested fat
For severely obese patients, neither med has shown promising long-term weight loss
Eligibility for weight loss surgery:
- BMI > 40kg/m2 without associated comorbidity
- or BMI 35kg/m2 or greater with comorbidity
- failed nonoperative weight loss attempts
- psychiatrically stable without substance abuse
- knowledge of the operation & sequelae
- medically safe to undergo surgery
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