Multidisciplinary Approach Involving Bariatric Surgery to Metabolic Disease Management

Obesity – a chronic, multifactorial disease with significant social and economic burdens, negatively affects daily life, social interactions, and reduces life expectancy. Bariatric surgery has become an effective solution for managing obesity and preventing the progression of obesity-associated metabolic diseases. However, it does not guarantee complete weight loss or prevent weight regain. Super-obese patients may face higher surgical risks, and psychological factors or poor dietary habits can limit success.

Various complementary treatments, alongside bariatric surgery, have gained attention to improve outcomes. These multidisciplinary interventions provide better long-term results compared to single treatments and enhance patients' mental health and quality of life.

Various adjuvant therapies for managing obesity include:

• GLP-1 Receptor Agonists (GLP-1RA): Effective for controlling weight and blood sugar, particularly in patients with inadequate weight loss or glycemic control – after surgery. Not suitable for patients with high thyroid cancer risk.
• Topiramate: Useful for patients who regained weight due to binge eating disorder (BED) after bariatric surgery. More research is needed on its long-term safety.
• Probiotic Therapy: May reduce inflammation and promote weight loss after surgery—especially in patients with small intestinal bacterial overgrowth (SIBO).
• Argon Plasma Coagulation (APC): A simple, low-cost option for patients who experience weight regain post-surgery. The risks of anastomotic ulcers need to be managed.
• TORe (Transoral Outlet Reduction): Helps correct anatomical changes after weight regain, providing long-lasting results with minimal trauma.
• Endoscopic Gastric Plication and Sleeve Gastroplasty: Noninvasive options for patients with dilated stomachs post-surgery, although further studies are needed to explore potential complications.
• Plastic Surgery: Beneficial for patients with body deformities following rapid weight loss. Higher BMI post-surgery increases risks.
• Lifestyle and Psychological Interventions: These interventions address cognitive and emotional disorders in obese patients, improving long-term weight management.

Combining bariatric surgery with multidisciplinary care maximizes long-term benefits for obese patients. Continued follow-up and personalized treatment plans are key to addressing physical and mental health.

Source: Xie J, Wang Y. Int J Surg. 2024;110(6):3666-3679. Published 2024 Jun 1. doi:10.1097/JS9.0000000000001320