Medical scientists are becoming aware that obesity is a complex, chronic disease of dysregulated metabolism. There are over a thousand genes that affect the regulation of the body’s metabolism. Differences in these genes can lead to obesity. Weight gain is one symptom of obesity, but it also manifests as diabetes, fatty liver disease, hormonal imbalances, cardiovascular disease, and increased incidence of many cancer types. Environmental factors interact with these genes and influence which symptoms a person develops. Like many chronic diseases, obesity will never be cured, but can be put into remission with proper treatment.
The body has a “Set Point” that determines how much a person weighs. If someone’s weight varies from this set point, the body has mechanisms to gain or lose weight to return back to the set point. An example of varying this set point is weight gain during pregnancy. The body raises the set point to ensure the mother has enough stored energy (fat) to provide for the baby’s development. In pregnancy, hunger and cravings increases and satiety decreases. This results in changes in behavior that cause weight gain, i.e. the stereotypical eating for two or craving ice cream and pickles. These changes are no different than when someone with obesity is told to restrict their diet to lose weight. Lower calorie diets are effective temporarily. However, once the weight is below the set point, the body increases hunger and cravings and decreases satiety (feeling full), metabolic rate, and energy expenditure. This will change behavior and cause weight loss to stop, often leading to weight regain.
Effective treatments of obesity can help alter the set point. Anti-obesity medications will reduce cravings and increase satiety until the new set point is reached. This makes altering habits and dietary choices possible. Once the new set point is reached, new or additional treatments are necessary. Surgical treatments for obesity are the most effective. Minimally Invasive Procedures lower the set point substantially, and thus post surgical patients will have less hunger and fewer cravings until the new set point is reached. Once a person reaches that new set point, additional treatment with medications become more effective. For the remainder of a surgery patient’s life they still are treating obesity with the surgery, even if the disease progresses and addition treatment with medication or revision surgery is required.
The term “Bariatric and Metabolic Surgery” refers to two areas in which surgery addresses obesity. “Bariatric” references issues related to weight. Improvements with weight loss are innumerable: tying shoes, climbing stairs, fitting in an airplane seat or booth, less joint damage, less cardiovascular strain, resolution of sleep apnea, less gastric reflux, and many more. “Metabolic” references issues related to obesity’s dysregulation of metabolism. Improvements with metabolic changes that surgery causes are also innumerable: improved blood glucose and diabetes, improved blood vessels, less chance for heart attack, less risk of stroke, less risk of nerve damage, reversal of non-alcoholic fatty liver disease (NAFLD) or non-alcoholic steatohepatitis (NASH), less migraines, resolution of polycystic ovarian syndrome, improved fertility, substantial decrease in risks for a wide range of cancers, and many more. Following bariatric and metabolic surgery to treat obesity, the overall survival rate increases. This means a person if far less likely to die early after surgery than if they were living with obesity.