Wahiba Elhag

By Wahiba Elhag and Walid El Ansari

Worldwide, the numbers of laparoscopic sleeve gastrectomy (LSG) performed grown exponentially over the last decade, because of its simplicity, safety profile and excellent outcomes in terms of durable weight loss and improvement of obesity-associated comorbidities. This chapter will provide a comprehensive review on the outcomes of LSG as a metabolic surgery. It appraises LSG’s short, mid and long term weight loss outcomes, and compares these outcomes with those of other types of bariatric surgery. Then, a wider range of LSG outcomes are discussed, including a variety of comorbidities, clinical, biochemical and inflammatory parameters, while appraising the positive metabolic effects of LSG. The chapter also outlines the issues pertaining to LSG among a range of special populations such as adolescents, the elderly, renal transplant patients and others. The chapter concludes with a review of the safety and most common complications that may be encountered in the short term and long term, including surgical and nutritional complications, as well as mortality.

Part of the book: Bariatric Surgery

By Wahiba Elhag and Walid El Ansari

Despite successful weight loss after bariatric surgery (BS), weight regain (WR) may occur on long term following most bariatric procedures, with 20–30% of patients either failing to reach their target weight goals or failing to maintain the achieved weight loss. Significant WR has important health consequences, including the reversal of the improved obesity-related comorbidities and psychological function leading to decreased quality of life. Given the challenges faced by these patients, there is a need for multidisciplinary approaches to deal with WR. This chapter addresses the issue of WR among bariatric patients. It starts with the various definitions of insufficient weight loss and WR and the prevalence of weight regain by type of bariatric procedure. The chapter then explores the underlying causes as well as the predictors of WR. It will also outline the behavioral and psychotherapeutic, dietary and exercise strategies employed in the prevention of post-surgery WR. The chapter will then highlight the non-surgical and surgical approaches used in the management of WR. The chapter will conclude with a summary of the findings emphasizing that WR is complex and multifactorial, requiring multidisciplinary and multimodal dietary, behavioral, pharmacological, and surgical management strategies tailored to meet the individual needs of each patient.

Part of the book: Bariatric Surgery

By Wahiba Elhag and Walid El Ansari

Bariatric surgery (BS) results in significant weight loss and improvement of obesity associated comorbidities. Despite the benefits achieved with these operations, deficiencies of vitamins and other micronutrients are common. Such deficiencies may become clinically significant if not discovered and treated early. Therefore, it is imperative to undertake thorough screening, and have sound preventive strategies in place in order to make BS a safer procedure. This chapter will provide the multidisciplinary bariatric team with a comprehensive review of micronutrient deficiencies before and after bariatric surgery. The focus will be on the most common micronutrient deficiencies that are encountered in various types of BS procedures, including water soluble vitamins, fat-soluble vitamins, minerals and trace elements deficiencies, as well as protein malnutrition. The chapter starts with an overview of the causes of micronutrient deficiencies in patients with obesity and before undergoing BS. It reviews the screening of patients for preexisting micronutrient deficiencies prior to their BS. Then the chapter addresses the potential causes and mechanisms leading to such deficiencies after BS. It then conducts an in depth discourse of the prevalence of deficiencies by the type of BS, the presenting symptoms, and the investigations required for the diagnoses. The chapter will also discuss the management of each deficiency according to the severity of the symptoms. The chapter also reviews the recent updated guidelines for standard nutritional care post BS. We will finally conclude with a framework of the preventive strategies for optimal care to ensure long term success post-surgery.

Part of the book: Bariatric Surgery

By Wahiba Elhag and Walid El Ansari

A wide and interacting range of individual, environmental and socioeconomic factors contribute to obesity. As a consequence, weight management strategies almost always comprise a mixture of several parallel approaches, each with its challenges and unique goals. Broadly, weight management strategies comprise of two main strands. The non-pharmacotherapy approach includes various lifestyle modifications in terms of dietary therapy, exercise, and behavioral modifications, including the prevention of possible relapses. Pharmacotherapy, on the other hand, involves several anti-obesity medications, employed as single or combination therapy. Generally, the goals of weight management should be realistic and individualized to patient’s experiences, abilities, and risks in order to maximize the likelihood of success. This chapter tackles these weight management strategies in turn, explaining each, as well as highlighting their distinctive features and challenges, effectiveness and safety, requisites, and where appropriate, indications and contraindications.

Part of the book: Weight Management