Metabolic & Bariatric Surgery

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Metabolic & Bariatric Surgery
2013-10-19 15:29:59

Bariatric Surgery
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  1. Definition of morbid (aka, clinically severe) obesity is:
    • 100lbs over ideal body weight
    • twice ideal body weight
    • or BMI of 40kg/m2 or greater
  2. 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
  3. What influences ghrelin levels?
    Ghrelin increased by weight loss & caloric restriction

    Ghrelin decreased after gastric bypass
  4. Diet for medical management of morbid obesity =
    very-low-calorie, restriction of fat or carbohydrate intake
  5. 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
  6. Eligibility for weight loss surgery:
    • BMI > 40kg/m2 without associated comorbidity
    • or BMI 35kg/m2 or greater with comorbidity

    • and:
    • failed nonoperative weight loss attempts
    • psychiatrically stable without substance abuse
    • knowledge of the operation & sequelae
    • medically safe to undergo surgery