Metabolic Concerns and Bariatric Surgery

Bariatric surgery may pose a significant opportunity and challenge for individuals who have underlying metabolic conditions that contributed to their obesity—hyperglycemia, hyperinsulinemia, hypertriglyceridemia, hypercholesterolemia, insulin resistance, hypothyroidism, polycystic ovary syndrome (PCOS), and genetic factors like methylene tetrahydrofolate reductase (MTHFR). Obesity results from the following five basic etiologies, according to Plaisted and Istfan [1]:

  • • Hyperphagia—abnormally increased appetite for consumption of food associated with injury to hypothalamus
  • • Reduced physical activity
  • • Endocrine disorders—adrenal, thyroid
  • • Sympathetic nervous system dysfunction—hypertension
  • • Dysinsulinemia—enhanced adipose deposition

Obesity predisposes an individual to cardiovascular risk factors such as dyslipidemia, type 2 diabetes (T2DM), nonalcoholic fatty liver disease (NAFLD), and hypertension [2]. Roux-en-Y gastric bypass (RYGB)-induced sustained weight loss can result in metabolic improvement compared with pharmacological interventions.

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