Surgical treatment of morbid obesity

1. Big picture

Morbid obesity is not simply excess body weight; it is a chronic metabolic disease associated with diabetes mellitus type 2, hypertension, obstructive sleep apnoea, non-alcoholic fatty liver disease, cardiovascular disease, infertility, osteoarthritis, gastroesophageal reflux disease, depression, and increased operative risk.

Bariatric/metabolic surgery is the most effective long-term treatment for selected patients with severe obesity. It works not only by restriction or malabsorption, but also by changing gut hormones, satiety, bile acid metabolism, insulin sensitivity, and appetite regulation.

For the surgery final exam, the examiner wants:

Who needs surgery?
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Which operation is suitable?
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How do we prepare safely?
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What complications kill early?
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What lifelong nutritional problems must be prevented?

Current guideline-style criteria still commonly use BMI ≥40 kg/m², or BMI 35–39.9 kg/m² with a significant weight-related disease, with lower thresholds in some high-risk ethnic groups and selected metabolic disease contexts. NICE also recommends referral for comprehensive bariatric assessment at BMI ≥40, or BMI 35–39.9 with a significant condition that could improve with weight loss, and emphasizes long-term follow-up after surgery. ([NICE][1])

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