What Is a Bariatric Surgeon?

Portrait of confident surgeon in operating room
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There are a number of different physician specialties that focus on or treat and manage obesity. One of these is the bariatric surgeon.

What Is a Bariatric Surgeon?

A bariatric surgeon, simply put, is a surgeon who specializes in bariatric surgery, which is also commonly referred to as weight-loss surgery. There are many treatments for obesity, beginning with lifestyle changes (including diet and exercise) and progressing to medications and surgical operations, and the bariatric surgeon performs those operations.

What Does a Bariatric Surgeon Do?

There are many weight-loss procedures now available, including gastric bypass surgery, gastric banding (lap band) and sleeve gastrectomy (gastric sleeve), among others. A bariatric surgeon will evaluate a patient who has usually been referred to him or her by another physician or healthcare professional, and determine whether or not that patient is an appropriate candidate for one of these weight-loss operations.

Who Is Eligible for Bariatric Surgery?

Candidates for bariatric surgery meet very specific criteria. According to the latest obesity guidelines released by the American Heart Association (AHA), the American College of Cardiology (ACC), and The Obesity Society (TOS), bariatric surgery may be an option for adult patients who meet the following criteria.

These criteria include a body mass index (BMI) of 40 or greater, or a BMI of 35 or greater in a patient who has other medical conditions (known as “comorbid conditions”) caused by obesity.

The obesity guideline writing committee did not find sufficient evidence to recommend bariatric surgery for patients who have BMIs that fall below these cutpoints.

The guideline further advises primary care doctors and others caring for patients with obesity with high BMI to try “behavioral treatment with or without pharmacotherapy” first, and then if this has not worked along with other diet and lifestyle measures to achieve sufficient weight loss, bariatric surgery may be considered.

What Training Does a Bariatric Surgeon Have?

A bariatric surgeon will first have completed four years of college, four years of medical school, a surgical residency (usually of at least five years’ duration) and often advanced fellowship training beyond that, specifically for bariatric surgery. So a bariatric surgeon could easily have had 15 years of study and training past secondary school!

How Effective Is Bariatric Surgery?

Initial evidence points to gastric bypass and gastric sleeve procedures being more effective than gastric banding in terms of the magnitude of weight loss. For instance, research has found sleeve gastrectomy to result in an average 65% excess weight loss.

Additionally, gastric bypass appears to be more effective than gastric banding for reducing the rates of chronic diseases that are associated with obesity, such as Type 2 diabetes, high blood pressure, and high cholesterol.

In spite of the evidence thus far, however, longer-term follow-up studies are needed, as no studies of bariatric surgery appear to report outcomes beyond five years.

Thus, although the initial weight loss numbers are known, what is not known is how much weight loss is maintained over seven or ten years or even longer.

Sources:

Jensen MD, Ryan DH, Apovian CM, et al. 2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity Society [published online November 27, 2013]. J Am Coll Cardiol.

Ben-David K, DeMaria EJ. New guidelines for bariatric surgery fellowship training. General Surgery News. June 2007, Volume 33:06. Accessed online at http://www.generalsurgerynews.com/ViewArticle.aspx?d_id=71&a_id=8022 on October 9, 2015.

Puzziferri N, Roshek TB, Mayo HG, et al. Long-term follow-up after bariatric surgery: a systematic review. JAMA 2014;312:934-942.

Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA 2004;292:1724-1737.

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