Surgical Options and Criteria for Bariatric Surgery

Abstract

A 41-year-old male presents for follow-up of weight management. He has struggled with obesity for most of his adult life and is currently at his highest weight of 300 lbs. He states that he cannot stop eating until he is “uncomfortably full” and sometimes eats because of stress and not necessarily hunger. In the past, he has successfully lost weight through commercial weight loss programs but has been unable to keep the weight off for more than 1 year. The most weight that he has ever lost was approximately 20 lbs. Because of his weight, he has difficulty walking and climbing stairs. He denies daytime somnolence, joint pain, exertional dyspnea, binge eating, or depressed mood. Past medical history is significant for hypertension, type 2 diabetes mellitus (T2DM), gastroesophageal reflux disease (GERD), and dyslipidemia. His medications include hydrochlorothiazide 25 mg daily, atorvastatin 40 mg daily, metformin 500 mg daily, and omeprazole 40 mg daily. Physical exam is notable for a body mass index (BMI) of 43 kg/m² but is otherwise unremarkable. Labs reveal normal complete blood count, basic metabolic panel, and liver function tests. His fasting lipid panel is as follows: total cholesterol 184 mg/dL, LDL 97 mg/dL, HDL 30 mg/dL, and triglycerides 155 mg/dL; and his hemoglobin A1c is 7.4%. Today the patient inquires about his surgical options and would like to know if surgery is an option for him.