Determining the appropriateness of bariatric surgery involves a comprehensive evaluation by medical professionals to assess the severity of obesity and associated health risks. Here’s how healthcare providers diagnose the need for bariatric surgery:

1. Initial Assessment: The diagnostic process typically begins with an assessment of the patient’s medical history, including weight history, previous weight-loss attempts, and existing health conditions exacerbated by obesity. The Body Mass Index (BMI) is a primary screening tool, with a BMI of 40 or higher indicating severe obesity. For individuals with a BMI between 35-40, surgery may be considered if significant obesity-related health problems are present.

2. Physical Examination: A thorough physical examination helps evaluate the impact of obesity on the body, including assessing joint health, mobility, and signs of conditions like hypertension, diabetes, and sleep apnea. The examination also helps identify any anatomical factors that may influence the choice of bariatric procedure.

3. Psychological Evaluation: Given the psychological impact of severe obesity, patients often undergo a psychological evaluation to assess their mental health, emotional readiness, and understanding of the lifestyle changes required post-surgery. This evaluation helps ensure that patients have realistic expectations and are mentally prepared for the challenges and benefits of bariatric surgery.

4. Laboratory Tests: Laboratory tests such as blood tests are conducted to assess overall health and screen for conditions such as diabetes, high cholesterol, and nutritional deficiencies that may influence the surgical approach and postoperative management.

5. Dietary Assessment: Nutritional assessments are crucial to determine current dietary habits, nutritional deficiencies, and readiness to adhere to the dietary guidelines essential for postoperative success. Dietitians play a significant role in educating patients about dietary changes and ensuring they understand the dietary modifications required after surgery.

6. Consultation with Specialists: Patients may also consult with various specialists such as endocrinologists, cardiologists, and pulmonologists to evaluate the impact of obesity on specific organ systems and to optimise medical management before surgery.

7. Multidisciplinary Review: Bariatric surgery decisions are often made in a multidisciplinary team setting, where surgeons, dietitians, psychologists, and other healthcare professionals review the patient’s case holistically. This collaborative approach ensures that all aspects of the patient’s health and readiness for surgery are thoroughly considered.

The treatment aims to achieve significant weight reduction by altering the anatomy of the digestive system, which in turn limits food intake, reduces nutrient absorption, and can lead to metabolic changes beneficial for weight loss.

1. Types of Bariatric Surgery

• Biliopancreatic Diversion with Duodenal Switch (BPD/DS): BPD/DS is a complex procedure that involves removing a portion of the stomach and rerouting the small intestine to limit food intake and nutrient absorption. It results in significant weight loss and improvement in obesity-related conditions but requires careful long-term nutritional management due to malabsorption.
  
• Gastric Bypass (Roux-en-Y): Gastric bypass surgery creates a small stomach pouch and connects it directly to the small intestine, bypassing most of the stomach and a portion of the intestines. This reduces food intake and nutrient absorption, leading to substantial weight loss. It is effective for long-term weight reduction and improving metabolic conditions like diabetes.
  
• Sleeve Gastrectomy: In this procedure, about 80% of the stomach is removed, leaving a tube-like structure. It restricts the amount of food that can be consumed and reduces hunger by decreasing the hormone ghrelin. Sleeve gastrectomy offers significant weight loss with fewer complications compared to more complex surgeries.
  

2. Procedure and Care

• Surgical Procedure: During bariatric surgery, patients are placed under general anaesthesia. The surgeon then performs the chosen procedure using laparoscopic (minimally invasive) techniques, which involve making small incisions in the abdomen and using specialised instruments and a camera for visualisation. Some surgeries may require open surgery depending on the patient’s anatomy and other factors.
  
• Postoperative Management: After surgery, patients are closely monitored in the hospital for initial recovery and to ensure there are no immediate complications such as bleeding or infection. Pain management and early mobilisation are essential parts of the recovery process.
  
• Dietary Changes and Nutrition: Following bariatric surgery, patients must adhere to a specific diet progression designed to allow the stomach to heal and adapt to its reduced size. Initially, a liquid diet is followed, gradually progressing to soft foods and then solid foods. Dietary guidelines emphasise high-protein, low-calorie intake to support weight loss and prevent nutritional deficiencies.
  
• Follow-Up Care: Long-term success after bariatric surgery requires ongoing medical follow-up and support. Patients attend regular appointments with healthcare providers to monitor weight loss progress, nutritional status, and manage any complications or adjustments needed. Behavioural and lifestyle changes, including increased physical activity and healthy eating habits, are crucial for maintaining weight loss and overall health.
  

Bariatric surgery is not only about achieving weight loss but also improving overall quality of life by reducing obesity-related health risks and enhancing well-being. The comprehensive approach involves collaboration among surgeons, dietitians, psychologists, and other healthcare professionals to ensure patients receive optimal care and support throughout their weight loss journey.