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Greater than 40% of Individuals are overweight, in keeping with the Facilities for Illness Management and Prevention (CDC). And the epidemic is not slowing down, leading to hundreds of thousands of individuals affected by well being situations which may be related to weight problems, reminiscent of bronchial asthma, coronary heart illness, stroke, kind 2 diabetes, some cancers, and sleep apnea.
Jonathan Carter, MD, has helped sufferers drop some pounds for greater than a decade, as a part of the UCSF Bariatric Surgical procedure Heart. His crew has carried out greater than 3,500 weight-loss procedures because it began in 1998. Surgical procedures are safer, with greater than 99% of sufferers handled laparoscopically with small incisions utilizing tiny cameras to see inner organs.
We requested Carter how bariatric surgical procedure works and the way a brand new era of weight-loss medicine is altering some sufferers’ lives.
GLP-1 medicine like Ozempic and Wegovy are all the fad. Why not use them as a substitute of surgical procedure?
We consider weight problems on a spectrum. If it’s essential to lose 10 to twenty kilos, a life-style intervention is greatest. If it’s essential to lose 30, 40, 50 kilos and metabolic ailments like diabetes, sleep apnea, hypertension are beginning to creep in, that is when modifications to eating regimen and workouts are insufficient as a sole intervention, so GLP-1s are additionally thought-about. I am an enormous proponent of those drugs.
When is surgical procedure greatest?
Surgical procedure is most acceptable for folks with extreme weight problems; we’re speaking about sufferers who’re 100- or 150-pounds chubby. For these folks, way of life modifications and weight-loss medicine aren’t sufficient.
With extreme weight problems, drugs and way of life interventions are unlikely to regulate your cardiovascular and most cancers dangers to regular ranges. With surgical procedure, sufferers can common 30% to 35% of complete physique weight reduction within the first 12 months, versus 15% to twenty% for the drugs. Bariatric surgical procedure sufferers get extra well being advantages upfront. About 50% to 60% of surgical procedure sufferers with diabetes go into remission. Circumstances like hypertension, bronchial asthma, liver illness, sleep apnea, incontinence, arthritis can also resolve.
How does bariatric surgical procedure work?
Most sufferers get gastric sleeve surgical procedure wherein 80% of the abdomen is eliminated, leaving a skinny banana-shaped tube. Urge for food hormones are lowered, and meals is delivered to the small gut quicker, inflicting different hormones to be launched that make us really feel full. Just a few sufferers go for gastric bypass, wherein a small pouch is created from the highest of the abdomen, which is then linked to a part of the small gut.
Bypass could result in barely higher weight reduction, however in the long run the variations are minimal. It’s a riskier surgical procedure however could also be advisable for sufferers with extreme heartburn, because the sleeve could worsen heartburn in one-third of circumstances.
Stroll me by way of the method from first appointment to post-surgery.
At UCSF, we contemplate surgical procedure for these with a physique mass index (BMI) of 35 or increased. If they’ve metabolic ailments, reminiscent of hypertension or sleep apnea, we chill out the cutoff to 30.
At sufferers’ first surgical procedure appointment, we run labs to watch medical situations and an EKG to evaluate coronary heart well being. Now we have a multidisciplinary apply, so sufferers meet with a surgeon, nutritionist, psychiatrist, and doctor assistant. We make sure that each affected person has entry to major care. The surgical procedure takes an hour, sufferers spend one night time within the hospital, and so they usually take ache meds for a couple of days. About 95% sail by way of; the commonest aspect impact is gentle nausea and vomiting.
Not all sufferers lose as a lot weight as they’d hoped. What’s their subsequent step?
We see most impact round 18 to 24 months after surgical procedure, and we may even see a gradual mild-to-moderate regain within the years afterward, say 15 or 20 kilos.
A minority of sufferers expertise considerably much less weight reduction than we would hoped. That is the place our multidisciplinary strategy is available in. Some sufferers profit from including GLP-1 drugs. Nevertheless it’s additionally necessary to have a look at way of life interventions. In bariatric surgical procedure, we have turn into very profitable at suppressing starvation and inducing satiety, however some sufferers have not made a change of their behaviors, so our crew works with them.
Maybe it is treating sleep apnea—we all know that poor sleep contributes to weight problems. Maybe it is assessing their way of life: Are they a sweets eater, a nighttime eater, are they consuming heavy meals with enterprise purchasers? We attempt to deal with these behaviors earlier than surgical procedure, however many sufferers want long-term assist to assist them get again on observe.
How do you see the way forward for weight-loss therapy?
We’re seeing the event of recent GLP-1s that promise to be simpler for sufferers to take, extra highly effective, and, hopefully, cheaper. Though we will not rule out long-term dangers but, we’d begin to see sufferers get therapy earlier within the illness course of, when the BMI simply exceeds 30. That may be nipping weight problems within the bud earlier than bariatric surgical procedure must be thought-about.
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I am a bariatric surgeon. Here is methods to weigh GLP-1 or surgical procedure (2025, July 20)
retrieved 20 July 2025
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