As America’s collective waistband has expanded in recent decades, more and more people have undergone bariatric surgery to fight obesity and its associated health problems. The term “bariatric surgery” includes all surgical procedures that cause weight loss by limiting food intake and/or preventing absorption of excess calories. In the United States, the most common weight loss procedures are gastric bypass, gastric sleeve, gastric band, and, less commonly, biliopancreatic diversion with duodenal switch.
Because so many people have undergone weight-loss surgery, there are plenty of studies out there reporting the successes and/or challenges of these procedures within one or two years after surgery. Oddly, however, few studies have examined long-term (five or more years after surgery) outcomes. Additionally, readily available information for bariatric patients about the lifelong medical care they need is scarce.
“Lots of patients are not getting the guidelines and follow-up that would help them long-term,” says Dr. John Grider, an internal medicine physician at East Falls Internal Medicine in Idaho Falls. He provides follow-up care for bariatric patients. “Not only do they need a typical annual exam, they need additional testing. It is incredibly important for post-bariatric surgery patients to have regular visits with their doctor since complications can occur years afterward.”
Dr. Grider continues, “I don’t mean to be a downer about this; the benefits of weight-loss surgery clearly outweigh the risks.” According to the American Society for Metabolic and Bariatric Surgery, bariatric surgery improves or resolves more than 40 conditions related to obesity, reduces mortality from cancer by 60%, coronary artery disease by 56% and type 2 diabetes by 92%. But, as Dr. Grider explains, “these conditions don’t completely disappear in every patient.”
Bariatric surgeons are very good at giving their patients reasonable expectations when it comes to the resolution or improvement of chronic conditions like type 2 diabetes. Often, however, patients’ hopes for dramatically improved health eclipse reality.
“It’s hard for people to believe that the surgery didn’t cure their chronic conditions,” says Dr. Grider. “But the remission rate for diabetes is 44%. Sleep apnea can return, as can high blood pressure. Doctors need to monitor for those conditions, even decades after bariatric surgery.”
Long-term complications can be very serious. “Bariatric patients are especially at risk for developing ulcers, mainly along healed surgical incisions,” explains Dr. Grider. “This can be a life-threatening complication since patients don’t always realize they have bleeding ulcers until they end up in the emergency department with severe blood loss.” Medication can help prevent ulcer development, but annual follow-up is still crucial.
Malnutrition is one of the most common complications after weight-loss surgery. Lack of calcium can cause osteoporosis; lack of iron can cause anemia; and B12 deficiency can cause a host of health problems. Because the surgery limits the intake of food and makes it more difficult for the body to absorb nutrients, blood tests are needed to see if the patient’s body is getting enough vitamins and minerals.
Other complications include “dumping syndrome,” imbalance between good and bad gut bacteria in the intestines, internal hernias, gout, hypoglycemia, and, interestingly, increased depression levels and risk of suicide.
“I know, that doesn’t seem to make sense,” says Dr. Grider. “Initially, the weight loss, improved health, and increased mobility improve patients’ mental health. They feel really good. Over time, however, the drastic changes in lifestyle and the difficulty of maintaining weight loss can actually lead to worsening depression.”
What is Dr. Grider’s best advice for bariatric patients? “If you haven’t been to a doctor in a while, it’s time. Go see your doctor ASAP. Major, life-changing surgery needs regular check-ups. Even if you don’t have the same primary care provider that you had at the time of surgery, you can go to a new doctor and get the help you need.”
Dr. Grider is available for consultation for patients who need ongoing care after bariatric surgery. Contact East Falls Internal Medicine at (208) 535-4000.