A review on the beneficial effects of bariatric surgery in the management of obesity

ABSTRACT

Introduction

Obesity is a chronic disease with a complex interplay of multiple factors such as genetic, metabolic, behavioral, and environmental factors. The management of obesity includes; lifestyle modification, psychological therapy, pharmacological therapy, and bariatric surgery. To date, bariatric surgery is the most effective treatment for obesity by offering a long-term reduction in weight, remission of obesity-related complications, and improving quality of life. However, bariatric surgery is not equally effective in all patients. Thus, if we can predict who would benefit most, it will improve the risk versus benefit ratio of having surgery.

Areas covered

In this narrative review, we explore the question on who will benefit the most from bariatric surgery by examining the recent evidence in the literature. In addition, we investigate the predisposing predictors of bariatric surgery response. Finally, we offer the best strategies in the clinic to explain the potential benefits of bariatric surgery to patients.

Expert opinion

Bariatric surgery is an effective obesity management approach. Despite its efficacy, considerable variation of individual response exists. Thus, it is important to recognize patients that will benefit most, but at present very few predictors are available which can be clinically useful.

KEYWORDS:

• Bariatric surgery
• obesity
• benefit
• weight loss
• omics
• obesity management

Article highlights

• Bariatric surgery is the most effective treatment for obesity. However, there is a variation of individual response following bariatric surgery. Thus, there is a need to identify which patient that may benefit the most from surgery.

• Bariatric surgery has beneficial effects in several obesity-related complications such as type 2 diabetes, obstructive sleep apnea, hypertension, dyslipidemia, cancer, osteoarthritis, and urinary incontinence.

• To date, we are unable to predict patients’ responses to bariatric surgery but there is hope that genetic markers may become available in the near future.

• Variation in the outcomes of bariatric surgery is reduced when operating on identical twins and first-degree relatives but there is a larger variation in outcomes when operating on husbands and wives or people who share the same environment. This suggest that there may be biological factors that could predict responses following bariatric surgery.

• Genetic variation appears to predict weight loss after surgery. However, insufficient data at present means that these markers cannot yet be used in the clinical practice.

• The combination of omics technology such as proteomics, metabolomics and lipidomic may have potential to stratify and monitor patients with obesity in the future. This would optimize selection of patients more likely to benefit from different kinds of obesity treatment including surgery.

• There is a health economic benefit towards bariatric surgery in the management of obesity especially in patients with type 2 diabetes.

Declaration of interest

CE le Roux reports grants from the Irish Research Council, Science Foundation Ireland, Anabio, and the Health Research Board. He serves on advisory boards of Novo Nordisk, Herbalife, GI Dynamics, Eli Lilly, Johnson & Johnson, Glia, and Boehringer Ingelheim. CE le Roux is a member of the Irish Society for Nutrition and Metabolism outside the area of work commented on here. He was the chief medical officer and director of the Medical Device Division of Keyron in 2011. Both of these are unremunerated positions. CE le Roux was a previous investor in Keyron, which develops endoscopically implantable medical devices intended to mimic the surgical procedures of sleeve gastrectomy and gastric bypass. The product has only been tested in rodents and none of Keyron’s products are currently licensed. They do not have any contracts with other companies to put their products into clinical practice. No patients have been included in any of Keyron’s studies and they are not listed on the stock market. CE le Roux was gifted stock holdings in September 2021 and divested all stock holdings in Keyron in September 2021. He continues to provide scientific advice to Keyron for no remuneration.

The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.