Department of Internal Medicine, New York-Presbyterian Hospital/Weill Cornell Medical College, New York, NY (Dr. Barenbaum); Comprehensive Weight Control Center, Division of Endocrinology, Diabetes and Metabolism, Weill Cornell Medicine, New York, NY (Drs. Saunders, Igel, Shukla, and Aronne) srb9023@nyp.org
Dr. Aronne serves as a consultant to Eisai Co., Gelesis, GI Dynamics, Jamieson Laboratories, Janssen, Novo Nordisk, Pfizer, Real Appeal, Inc., and UnitedHealth Group Ventures; receives grant/research support from Aspire Bariatrics, AstraZeneca, and Eisai Co.; has an equity interest in BMIQ, Gelesis, Jamieson Laboratories, MYOS RENS Technology Inc., and Zafgen, Inc.; and serves on the board of directors of BMIQ, Jamieson Laboratories, and MYOS RENS Technology Inc.
Drs. Barenbaum, Saunders, Igel, and Shukla reported no potential conflict of interest relevant to this article.
The 3 illustrative vignettes presented in this article offer examples of patients with obesity who could benefit from bariatric surgery. Each has been unable to achieve or maintain sufficient weight loss to improve health outcomes with nonsurgical interventions alone.
CASE 1
Sleep apnea persists despite weight loss
Robin W, a 50-year-old woman with class-II obesity (5’8”; 250 lb; BMI, 38 ), OSA requiring continuous positive airway pressure (CPAP), hyperlipidemia, hypertension, and iron-deficiency anemia secondary to menorrhagia, and taking an iron supplement, presents for weight management. She has lost 50 lb, reducing her BMI from 45.6 with behavioral modifications and pharmacotherapy, but she has been unsuccessful at achieving further weight loss despite a reduced-calorie diet and at least 30 minutes of physical activity most days.
Long-term lifestyle changes and follow-up are critical to the success of bariatric surgery.
Ms. W is frustrated that she has reached a weight plateau; she is motivated to lose more weight. Her goal is to improve her weight-related comorbid conditions and reduce her medication requirement. Despite the initial weight loss, she continues to require CPAP therapy for OSA and remains on 3 medications for hypertension. She does not have cardiac or respiratory disease, psychiatric diagnoses, or a history of gastroesophageal reflux disease (GERD).
Is bariatric surgery a reasonable option for Ms. W? If so, which procedure would you recommend?
Good option for Ms. W: Sleeve gastrectomy
It is reasonable to consider bariatric surgery—in particular, SG—for this patient with class-II obesity and multiple weight-related comorbid conditions because she has been unable to achieve further weight loss with more conservative measures.
