Bariatric Medicine and the Treatment of Obesity

bariatric doctor and obese patient
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Bariatrics is the branch of medicine that deals with the study, treatment, and prevention of obesity. The word bariatrics is derived from the Greek root baro- which means heavy or large. The field of bariatrics encompasses diet, exercise, therapy, medications, and surgeries--all aimed at achieving and sustaining weight loss.

A healthcare provider can specialize in bariatrics but is not necessarily a surgeon. A nutritionist specializing in bariatrics would be someone specializing in helping patients prevent or overcome obesity, just as a therapist specializing in bariatrics would provide therapy services to those same individuals. Many areas of healthcare can have individuals who specialize in bariatrics.

The most common use of the term "bariatrics" is in reference to the area of medicine that treats obesity with surgical options. Bariatric surgery involves procedures to either temporarily or permanently reduce the size of the stomach or to decrease the amount of food that can be digested and used as calories in the body. Some bariatric procedures do both, such as the roux en y, a procedure that both reduces stomach size and decreases the amount of calories the body can absorb.

Education and Certification of Bariatric Surgeons

Physicians practicing bariatric medicine in the U.S. may be board-certified by the American Board of Obesity Medicine (ABOM). Typically, a physician will complete a residency in family medicine, internal medicine, or general surgery before pursuing additional training to attain the ABOM certification.

Bariatric surgeons are physicians trained in surgery including bariatric surgical procedures. Non-surgeon practitioners specializing in the treatment of obesity are known as bariatricians. In addition to dealing with obesity, bariatricians are typically well-versed in associated illnesses that are often present alongside obesity, including diabetes, arthritis, and heart disease.

Non-Surgical Treatment Approaches

While bariatricians will typically focus on non-surgical interventions in first-line treatment, research suggests that these only have a limited short-term success and very poor long-term success. Early interventions may include monitored diets, structured exercise programs, and intensive behavioral therapies to target and fix poor eating habits.

Medications may also be used. Among them:

  • Belviq (lorcaserin) suppresses the appetite by activating a serotonin receptor that regulates the gut activity.
  • Byetta (exenatide) is used to treat type 2 diabetes but can also promote weight loss by slowing the emptying of the stomach and making a person feel fuller faster.
  • Glucophage (metformin) is also used in diabetics but can also reduce weight by decreasing the amount of glucose produced by the liver while increasing the absorption of glucose in muscles.
  • Qsymia (phentermine and topiramate) combines an appetite stimulant with an anticonvulsant believed to contribute to weight loss.
  • Xenical (orlistat) reduces intestinal fat absorption by inhibiting pancreatic enzymes that break down fat.

Bariatric Surgery

Bariatric surgery is one of the central features involve in bariatric medicine. Bariatric surgeons require a fellowship of a year or more following completion of a general surgery residency. This advanced training provides hands-on experience in performing different types of weight loss surgery.

Bariatric surgery is generally considered in persons with a body mass index (BMI) of 40 kg/m2 or greater in whom non-surgical interventions have failed.

Among the surgical options:

  • Adjustable gastric banding (also known as a lap band) is performed laparoscopically and involves the use of a non-permanent silicone band that restricts the size of the stomach.
  • Gastric bypass surgery (the most common form of which is the Roux-en-Y bypass) is designed to reduce the amount of food a person is able to eat cutting away a portion of the stomach.
  • Gastric balloon is a minimally invasive technique involving the placement of a deflated balloon inside the stomach which is then inflated to reduce the gastric space.
  • Sleeve gastrectomy (also known as a gastric sleeve) involves the non-reversible reduction of the stomach by around 15 percent by removing a sleeve-like portion of the organ.
  • Vertical banded gastroplasty (also known as stomach stapling or the Mason procedure) involves the permanent stapling of the stomach to create a smaller stomach pouch.

A Word From Verywell

The specialty of bariatrics is a fairly new one, but great strides are being made in the treatment of obesity both with surgery and without. For individuals who are obese, there are many types of treatment available ranging from dietary interventions to surgical procedures to reduce the calories available to the body. For the individual who is obese and would like to lose excess fat, there are many options available. 

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  • Gloy, V.; Bhatt, D.; Kashyap, S. et al. "Bariatric surgery versus non-surgical treatment for obesity: a systematic review and meta-analysis of randomized controlled trials." BMJ. 2013;347:f5934. DOI: 10.1136/bmj.f5934.