Surgery for severe obesity

Surgical therapy for weight loss is an effective treatment for patients with severe obesity who also present with obesity-related comorbidities. Surgical approaches include both restrictive and malabsorptive procedures that will induce weight loss and improvement of comorbid conditions. Comprehensive care provided by a multidisciplinary team is essential for the bariatric patient both pre- and postoperatively. Roux-en-Y gastric bypass, biliopancreatic diversion, and biliopancreatic diversion with duodenal switch pose a greater risk for nutrient malabsorption and deficiency than the laparoscopic adjustable gastric banding or sleeve gastrectomy. Metabolic and clinical deficiencies may become clinically significant if not recognized and treated. Counseling, monitoring, and supplementation are essential for the treatment and prevention of metabolic complications after bariatric surgery. This chapter reviews the pathophysiology and clinical aspects of bariatric surgery, preoperative and postoperative management of the bariatric patient, nutrient deficiencies, and guidelines for nutritional management of adults after bariatric surgery.