Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Bariatric Medicine”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 19 recordsLinked to original sources
PubMedDate not supplied

Current issues and challenges in the management of bariatric patients.

Morbid obesity is an increasingly common healthcare problem, and providers and patients currently face numerous challenges in dealing with this problem effectively. Issues addressed in this article include the effect of stigma, the need for more evidence regarding effective management options, and the declining insurance coverage for bariatric surgery. The role of bariatric surgery in effective management of morbid obesity is discussed, along with the effect on and possible reasons for declining coverage. A comparison between benefits and coverage for bariatric surgery and angioplasty/stent placement is included.

Angioplasty↗
PubMedDate not supplied

Surgical treatment for obesity: ensuring success.

In the United States, obesity has reached epidemic proportions. Serious medical complications, impaired quality of life, and premature mortality are all associated with obesity. Medical conditions such as type 2 diabetes mellitus, hypertension, hyperlipidemia, or sleep apnea can improve or be cured with weight loss. Medical treatment programs focused on diet, behavior modification, and/or pharmacologic intervention have met with limited long-term success. Although surgical treatments for obesity have become popular in recent years, they should only be used as a last resort for weight loss. Not all patients can be considered appropriate candidates for surgery; therefore, guidelines based on criteria from the National Institutes of Health should be used preoperatively to help identify suitable persons. Most individuals who opt for weight-loss surgery have usually struggled for many years with losing weight and keeping it off, but surgery alone will not ensure successful weight loss. Patient education is imperative for long-term success. Moreover, any such educational regimen should include information on diet, vitamin and mineral supplementation, and lifestyle changes, as well as expected weight-loss results and improvements in comorbid conditions. Patients must be willing to commit to a long-term follow-up program intended to promote successful weight loss and weight maintenance and to prevent metabolic and nutritional complications.

Aftercare↗
PubMed2002

Evidence-based medicine: open and laparoscopic bariatric surgery.

BACKGROUND: The aim of this study was to perform an evidence-based analysis of the literature on open and laparoscopic surgery for morbid obesity. METHODS: Human studies on surgery for morbid obesity were conducted. Multiple publications of the same studies, abstracts, and case reports were reviewed. Current Contents, MEDLINE, EMBASE, and Cochrane Library databases were investigated. RESULTS: Open Roux-en-Y gastric by pass (RYGB) for morbidly obese patients and long-limb RYGB for superobese patients are highly effective procedures. Randomized controlled trials comparing malabsorptive procedures with other bariatric operations are needed. The long-term efficacy of adjustable silicone gastric banding (ASGB) still is undetermined because of poor evidence. Laparoscopic RYGB is as safe as its open counterpart, although its long-term results are lacking. Laparoscopic ASGB is less invasive than open ASGB, although its efficacy cannot be determined because of poor evidence. Laparoscopic vertical banded gastroplasty (VBG) is becoming unpopular since the decreasing trend of open VBG. Laparoscopic biliopancreatic diversion with duodenal switch is feasible, but needs further studies. CONCLUSIONS: Randomized controlled trials comparing the various laparoscopic operations are strongly needed.

Anastomosis, Roux-en-Y↗
PubMed2006

Results of bariatric surgery.

Overweight and obesity are rapidly growing to epidemic proportions in the United States and globally. Since sustainable weight loss is only achieved by bariatric surgery, medicine has seen an explosion in the diversity and number of bariatric procedures performed over the past few years. Systematic studies of postoperative outcomes and investigations into the physiology and biology of weight loss provide a more comprehensive understanding of the sequelae of bariatric surgery. Adipose tissue is the predominant site of fat stores. Increasing obesity results in an overload of lipids within the body's natural storage sink (i.e., the adipocyte) followed by the necessary deposition of fat within ectopic sites such as muscle, liver, and pancreas. The resulting metabolic derangements are associated with insulin resistance, central obesity, and chronic inflammation as adipose tissue acts as an endocrine organ, producing and secreting a host of biologic mediators. Whereas there are conflicting data on the cardiovascular effects of peripheral, subcutaneous liposuction, malabsorptive bariatric procedures result almost universally in significant amelioration of insulin resistance, hypertension, dyslipidemia, and hepatic steatosis. Concomitant changes in adipocyte-derived hormones may provide mechanistic explanations to the observed improvements.

Bariatric Surgery↗
PubMed2006

Shared medical appointments: new concept for high-volume follow-up for bariatric patients.

BACKGROUND: Shared medical appointments (SMAs) are a new model in patient care. This model was designed to improve patients' access to their physicians and improve physician productivity. The aim of this study was to evaluate patient satisfaction with SMAs after bariatric surgery. METHODS: The medical records of consecutive patients who were followed up after bariatric surgery were retrospectively reviewed. The type of bariatric surgery and type of medical appointment were recorded, as were the patients' replies to the evaluation questionnaires in the SMA group. RESULTS: From April 2004 to December 2004, 277 individual visits were conducted; 242 visits for patients who underwent Roux-en-Y gastric bypass and 35 visits for patients who underwent laparoscopic gastric banding. Thirty-three SMAs occurred during that period--28 SMAs for patients who underwent Roux-en-Y gastric bypass and 5 SMAs for patients who underwent laparoscopic gastric banding. Of the patients who initially participated in an SMA, 91% scheduled a subsequent SMA, and 96% indicated that they would recommend SMAs to others. On a scale of 1 to 5 (1, poor and 5, excellent), patients graded their overall experience with SMAs as 4.5. Other parameters in the questionnaire all ranked between 4 and 5. The average waiting period for an appointment before the implementation of SMAs was 57.7 days (range 50-65) for new patients and 50 days (range 20-72) for former patients. After the implementation of SMAs, the average waiting period was 25 days (range 8-42) for new patients (P = 0.0046) and 20.3 days (range 0-42) for former patients (P = 0.06). CONCLUSION: The SMA offers the patient prompt access to medical care, enables high-volume follow-up, with high satisfaction rates.

Aftercare↗
PubMed2006

Avoiding embezzlement in the bariatric practice office.

There is an increase in the number of embezzlement problems in medical offices. Physicians may be unfamiliar with methods to avoid or limit this problem. Because multiple charges are common in bariatric clinics, they are especially at risk for this problem. In this article, we discuss internal control measures to avoid embezzlement.

Bariatric Medicine↗
PubMed2004

Surgical approach to adolescent obesity.

The obesity epidemic has resulted in the premature onset of traditionally adult diseases in children and adolescents. Bariatric surgery can be used to achieve significant weight loss and resolution of major and minor comorbidities of obesity. It is not known, however, whether weight loss or comorbidity resolution after adolescent bariatric surgery is sustainable over the lifetime, given the powerful biologic mechanisms that are thought to play an important role in development of severe obesity in these patients. There are also concerns about whether bariatric procedures may have unanticipated adverse nutritional consequences when applied in adolescence. Principles of adolescent medicine and evidence from adult bariatric surgical studies can be used to rationally guide the application of bariatric procedures to a group of young patients wither serious medical and psychological comorbidities of severe obesity. Given the immediacy of some of the medical and psychosocial complications, impaired quality of life, and the added health care costs of adolescent obesity, adolescent bariatric surgery programs should be developed to meet these needs. Adolescent bariatric surgery programs should have expertise that enables them to assess and meet the unique medical, cognitive, physiological, and psychosocial needs of the adolescent. Indications for operation during adolescence should be conservative until appropriately designed clinical studies have demonstrated the safety and efficacy of these techniques applied to adolescents.

Adolescent↗
PubMed2005

Presentation and management of common post-weight loss surgery problems in the emergency department.

Morbid obesity is an epidemic in this country. An increasing number of patients are undergoing weight loss surgery in an effort to combat the negative physical and psychological impact of morbid obesity. Fueling the increasing interest in surgical treatment of morbid obesity has been the development of new laparoscopic techniques. There are several surgical approaches to morbid obesity, and each has its own unique set of risks and potential complications. As more patients have weight loss surgery, clinicians working in the emergency department will frequently encounter complications of these procedures. To ensure timely diagnosis and optimal care, clinicians should be familiar with the standard weight loss approaches and the potential complications of these interventions.

Anastomosis, Roux-en-Y↗
PubMed2004

A multidisciplinary approach to the adolescent bariatric surgical patient.

PURPOSE: Pediatric obesity is an epidemic in the United States. As of yet, no surgical programs specifically dedicated to the management of clinically severely obese adolescents exist. The purpose of this report was to describe the establishment and early experience of a multidisciplinary Comprehensive Weight Management Center (CWMC) in a free-standing children's hospital. METHODS: With input from an ethicist, gastroenterologist, pulmonologist, endocrinologist, and adolescent medicine physician, guidelines for patient selection, evaluation, and bariatric surgical management were developed and implemented. Roux-en-Y gastric bypass (RYGBP) surgery has been performed using open and laparoscopic techniques. RESULTS: The average age and body mas index (BMI) for 79 patients referred to the CWMC has been 16 years and 54 kg/m2, for boys and 17 years and 51 kg/m2 for girls. Twenty-five percent have been considered appropriate for RYGBP, 25% have not met criteria for surgery, and 50% are being evaluated. Ten patients who have undergone RYGBP had comorbidities of their obesity, including type 2 diabetes mellitus (DM), obstructive sleep apnea syndrome (OSAS), pulmonary embolism, hypertension, dyslipidemias, and depression. Clinically significant weight loss with resolution of comorbidities has occurred in all patients. Significant complications have included leak from the gastric remnant, DVT, partial roux limb obstruction, and micronutrient deficiency. CONCLUSIONS: RYGBP is an effective means to treat obesity-related morbidity in the adolescent. A multidisciplinary team of pediatric specialists is needed for optimal preoperative decision making and postoperative management. Results have been satisfactory and justify a clinical trial to confirm the safety and efficacy of bariatric surgery in the adolescent population.

Adolescent↗
PubMed2005

Trends in insurance coverage for bariatric surgery and the impact of evidence-based reviews.

The recent increase in demand for bariatric surgery has placed mounting economic pressure on insurance companies and other third-party payers (TPPs). As a result, some of the TPPs have responded by excluding or limiting their coverage of all or certain types of bariatric surgical procedures, and cite as their reason, a lack of evidence that supports the safety and efficacy of such procedures. Over the years, so-called "evidence-based reviews" have been used to back these claims. Some of these reviews have significant flaws and limitations that are discussed.

Bariatrics↗