Weight Loss Surgery: Common Questions

It is often reported that weight loss surgery is the most effective weight loss method for extreme obesity.1 The number of procedures has increased dramatically during the past decade. From 1999-2001 to 2002-2004, the number increased more than ninefold, topping 100,000 procedures performed annually.2 Several studies have outlined the benefits of weight loss surgery on obesity-related comorbidities, including hypertension, hyperlipidemia, and diabetes.3 As the health-related benefits of weight loss surgery, particularly related to type 2 diabetes, continue to become elucidated, diabetes educators will be increasingly called on to provide pre- and postsurgery support to patients. This article outlines some common questions asked during patient visits and presents evidence-informed responses. Question: Are exercise and weight loss before bariatric surgery beneficial? Answer: The question of whether to encourage—or even require—weight loss before bariatric surgery remains debatable. However, recent studies point to the increasing benefits of modest weight loss in obese adults before surgery. Weight loss benefits related to the surgery itself include reduced liver size and reduced operating time. Extreme obesity often accompanies an enlarged, fatty liver. The increased size of the liver poses technical difficulties in terms of the surgeon's ability to view and maneuver during surgery, especially during laparoscopic procedures.4 Fris5 looked at the connection between preoperative weight loss and liver size and found that weight loss strongly correlated to reduction in liver size. Additionally, some studies have found that preoperative weight loss may lead to reduction in operating time.6,7 One study found that preoperative weight loss > 5% shortened operating time by 36 minutes.7 Patients who lose weight before surgery may be more successful at weight loss after surgery.6 Alvarado …