Overview of Obesity Surgery Preoperative Assessment and Preparation
Obesity, which is a condition of being excessively overweight, is a significant health concern in the United States, as it often leads to serious health problems like heart disease and diabetes, and could even result in early death. Studies have shown a clear connection between obesity and overall poor health. Concerningly, obesity is not just an issue confined to the US but is a worldwide health problem. According to data from the Centers for Disease Control and Prevention (CDC), approximately 93 million adults in the US are obese, which accounts for nearly 40% of the adult population. Being obese significantly increases the likelihood of developing diseases like diabetes and heart disease, and is one of the top preventable causes of death. Medical expenses linked to obesity are estimated to be around 147 billion dollars a year. Reliable and consistently effective medical treatments for obesity remain elusive. Currently, the most effective known treatment for obesity is bariatric surgery.
Bariatric surgery has gained considerable attention for its proven record of success in improving the health of those who are obese. This surgery can bring about significant improvements in the control and management of various health conditions often linked to obesity, such as diabetes, high blood pressure, sleep apnea, arthritis, and metabolic syndrome, which is a cluster of conditions that occur together, increasing your risk of heart disease, stroke, and type 2 diabetes. When compared to diet changes or medical treatments, bariatric surgery produces better long-term weight loss results for individuals with severe obesity. It also contributes to a noticeable decrease in overall death rates. However, people with obesity often also have other health problems that can complicate the surgery. Therefore, it’s crucial to have a thorough medical check-up before undergoing the operation to be fully aware of the implications.
This text discusses the preparation required for an obese person scheduled for bariatric surgery and the importance of a team of diverse healthcare professionals reviewing and managing the patient’s care before, during, and after the surgery.
Why do People Need Obesity Surgery Preoperative Assessment and Preparation
Surgery to help with weight loss, also known as bariatric surgery, has become increasingly popular over the past ten years. In fact, there are over 200,000 such procedures performed every year in the US and Canada alone.
Where a person falls on the scale of obesity is typically determined by their Body Mass Index, or BMI. This index is calculated by taking a person’s weight in kilograms and dividing it by their height in meters, squared. If a person’s BMI is between 20 to 25, they are considered to be of normal weight. For those with a BMI falling between 26 to 29.9, they’d be classified as overweight. Obesity comes into play when a person’s BMI is between 30 to 39.9. The categories continue, with those with a BMI of 40 or above being considered extremely obese, a BMI above 50 categorized as super-obese, and a BMI above 60 as super-super-obese.
According to the guidelines put forth by the Society of American Gastrointestinal and Endoscopic Surgeons, most notably known as SAGES, surgery for weight loss may be suggested if:
- A person’s BMI is more than 40, even if they have no other health conditions,
- A person’s BMI is between 35 to 39.9, and they have at least one other serious health issue, such as diabetes, high blood pressure, sleep apnea, or their quality of life is negatively affected.
- A person’s BMI ranges from 30 to 34.9, and they have certain health conditions like the metabolic syndrome or diabetes that isn’t improving with regular medical treatment.
It’s vital to bear in mind that before undergoing such surgery, patients are generally encouraged to join a weight loss program. This program would equip them with exercise routines and lifestyle changes, ensuring they’re ready to cope with the dietary restrictions after the surgical process.
Weight loss surgery can be achieved through methods that decrease absorption of food, limit the amount of food the stomach can hold, or a combination of both. While malabsorptive methods, such as bypassing parts of the small intestine, are less popular today, the restrictive procedures like vertical-banded gastroplasty (VBG), adjustable gastric banding (AGB), and sleeve gastrectomy, are more common. The Roux-en-Y gastric bypass (RYGB) is a procedure that combines both approaches. Sleeve gastrectomy, in particular, is one of the go-to weight loss surgeries in the US due to its simpler technical requirements, lower complication rates, and significant improvements in associated health conditions.
When a Person Should Avoid Obesity Surgery Preoperative Assessment and Preparation
There are several reasons why an individual might not be able to undergo weight loss surgery (bariatric surgery) including:
– Major depression or uncontrolled mental health issues. This means if a person is dealing with severe depression or other mental health issues that are not currently under control, they might not be suitable for this surgery.
– Current misuse of substances, including alcoholism. People who are currently having problems with substance abuse, like using drugs or alcohol excessively, may not be able to have this surgery.
– People who cannot or will not stick to the required dietary and supplement regimen after bariatric surgery. This means if a patient cannot follow the special diet and take nutritional supplements as instructed after surgery, they might not be a good candidate for it.
– People suffering from underlying eating disorders. If a person has an eating disorder, like bulimia or anorexia, they might not be able to have this surgery.
– Severe bleeding disorders (severe coagulopathies). This means if a person has a disorder that affects their blood’s ability to clot, it can make surgery too risky.
– Certain patient-related risks that could make the surgery too dangerous, like if the patient has a high risk for heart problems (cardiovascular risk) or complications with anesthesia (anesthetic risk).
Additionally, people who have a condition called gastroesophageal reflux disease (a disorder where acid from the stomach flows back into the food pipe causing discomfort), may not be suitable for a type of weight loss surgery called a sleeve gastrectomy. This type of surgery can sometimes make their condition worse.
Equipment used for Obesity Surgery Preoperative Assessment and Preparation
In the US, most weight-loss surgeries are carried out using a minimally invasive method. This type of surgery, called laparoscopic bariatric surgery, is linked with lower risk of complications, less pain for the patient, and a shorter hospital stay. Nevertheless, the decision to use a laparoscopic (minimally invasive) or open approach (a larger cut) often depends on what the surgeon is most comfortable and experienced with.
Preparing for Obesity Surgery Preoperative Assessment and Preparation
Before weight loss surgery (also known as bariatric surgery), the patient needs to go through a thorough evaluation process. This involves a team of specialists which includes endocrinologists, dieticians, psychologists, anesthesiologists, nurses, cardiologists, and a surgeon. It’s crucial to have this detailed check-up because it helps ensure a successful outcome from the surgery.
One of the first steps is making sure the patient is emotionally prepared for the surgery. This is done through a psychological evaluation. The patient’s background will be checked for any history of mental health issues, such as depression and eating disorders, any attempts at losing weight in the past, consistency with therapy, and misuse of substances.
If a patient is found to have problems with alcohol, they should go to rehabilitation and detoxification before surgery. They will need to show they have abstained from alcohol for at least a year before having the surgery. Smoking should also be stopped, as nonsmokers tend to have better surgery outcomes and fewer complications
The patient’s support system is also looked at closely. Studies have shown that patients with strong backing from families and their community are more likely to have a successful outcome.
Nutritional evaluation is another vital part of the pre-surgery process. Both the patient’s nutrition and their knowledge about nutrition after surgery will be assessed. It’s important for patients to know what to expect, including anticipated weight loss after their surgery. For example, someone who undergoes a sleeve gastrectomy should aim to lose about 60 to 65 percent of their excess body weight within two years. This weight loss target increases to 70 to 75 percent for those having gastric bypass surgery.
If the patient has diabetes, managing blood sugar levels is crucial. A licensed dietician is usually the one to carry out the nutritional evaluation.
Having a weight loss plan is an essential step. This should include a nutrition assessment and guided exercise plan. Patients should be monitored and their weight loss progress documented every visit before the surgery. If the patient fails to lose weight, this can provide an indication of how well they’ll adapt to lifestyle changes needed after surgery. If following the plan doesn’t result in weight loss, this should also be recorded so extra support can be given.
A detailed medical evaluation also must be done to make sure it’s safe for the patient to have bariatric surgery. This involves a review of their health and lifestyle, their medical and surgical history, social factors, and various medical tests. In addition, patients should be assessed for heart disease and sleep apnea, a condition where breathing stops and starts during sleep.
Imagery such as abdominal ultrasound is often needed to determine the best type of surgery. Other pre-surgery considerations may include an upper gastrointestinal endoscopy, a type of procedure that examines the upper part of the gastrointestinal (GI) tract. Following these steps can ensure that the patient is fit and prepared for the surgery. Note that recommendation for this procedure should come from The American Society of Metabolic and Bariatric Surgery.
The anesthesiologist typically checks the patient’s history and performs several assessments to point out possible complications linked to obesity. Conditions relating to obesity include heart disease, high blood pressure, stroke, type 2 diabetes, gastroesophageal reflux disease (heart burn), among others.
The heart’s function and lungs should be evaluated as well. A questionnaire may be used to diagnose obstructive sleep apnea (OSA), a common sleep-related breathing disorder in obese individuals. If at risk, the patient might be recommended for an overnight sleep study.
Overall, these evaluations are crucial to ensure the procedure is a success and to prevent post-surgery complications.
What Else Should I Know About Obesity Surgery Preoperative Assessment and Preparation?
Before a weight loss surgery, it’s crucial for doctors to thoroughly examine patients. This helps in deciding the right candidates for the procedure and ensuring the success of the surgery. The evaluation is tailored to each patient, considering their health issues, expectations, and the physical and mental factors that will play a role during and after surgery.
Thus, understanding and applying these steps is extremely important for the doctors and other medical staff who are working with patients being considered for weight loss surgery.
