6
Metabolic and Bariatric Surgery
Key Points
1. MBS is a durable and effective treatment for obesity and related
conditions.
2. Procedure selection should be individualized. The two most
common options are sleeve gastrectomy and Roux-en-Y gastric
bypass (RNYGB).
3. Eligibility now includes patients with a BMI of 30 kg/m² or higher
and metabolic disease, although insurers often use older criteria
(BMI of 40 kg/m² or higher or ≥35 kg/m² with comorbidities).
4. Obesity medicine clinicians play a crucial role throughout
the surgical process, from preoperative education and risk
assessment to long-term follow-up.
5. Nutrition is critical. Patients generally require 60 to 100 g of
protein daily to maintain lean muscle mass. Treatment plans
should reflect cultural preferences to support adherence and
promote effective care.
6. Diet progression involves a stepwise advancement from liquids
to solids postoperatively, with a continued emphasis on protein,
hydration, and supplementation.
7. Physical activity, encompassing both aerobic and resistance
training, enhances surgical outcomes, promotes weight loss, and
helps maintain muscle mass.
8. Complications such as dumping syndrome, vitamin and mineral
deficiencies, gastroesophageal reflux, and weight regain
require early recognition. Persistent abdominal or neurological
symptoms postoperatively should prompt further evaluation.
9. Lifelong monitoring for deficiencies (iron, vitamin B12, calcium,
vitamin D, fat-soluble vitamins) is essential. Annual laboratory
testing is recommended. Consider empiric intravenous thiamine
for patients at risk of deficiency and neurologic symptoms.
10. Accreditation matters: MBS should be performed in Metabolic
and Bariatric Surgery Accreditation and Quality Improvement
Program (MBSAQIP)-accredited centers. Revisional procedures
should be referred to high-volume, experienced programs.
Metabolic and bariatric surgery (MBS) refers to a group of surgical
interventions designed to induce durable weight loss and improve
or resolve obesity-related comorbidities through anatomic and
physiologic modifications of the gastrointestinal tract.
