Jornal de Obesidade e Terapêutica

Bariatric surgery: Challenges, barriers and future directions in the surgical treatment of morbid obesity

Bariatric surgery is the best way for long-term treatment for morbid obesity. Despite this fact, currently only 1% of people with morbid obesity, that is, 1 in 100 people, undergo bariatric surgery. There are numerous current challenges with surgical treatment of morbid obesity, such as low postoperative follow-up rates with only 30% of patients after one year. There is also significant weight recovery or insufficient weight loss after post-bariatric surgery, which may be an additional reason for the lack of postoperative follow-up.

In addition, there are several novel procedures for treating obesity that do not necessarily lead to a significant improvement in weight loss. Above all, surgical and medical approaches to obesity often do not address the underlying causes of obesity (eg, unhealthy diets, physical inactivity, etc.). There are also numerous barriers to surgical treatment of obesity, including selection criteria, costs associated with bariatric surgery, and the fact that certain minority ethnic groups do not seek bariatric surgery at the same rate as other ethnic groups. The objective of this presentation is threefold: First, to describe the current state of care and the results of bariatric surgery; second, describe the current challenges and barriers to seek pre and post bariatric care and third describe the process of comprehensive structuring of our pre and post surgical obesity treatment program to improve results. The overall objective is to issue a call to action to develop strategic plans to improve post-surgical weight loss and medical and psychosocial outcomes to improve overall management of surgical treatment for obesity. Obesity and metabolic syndrome are becoming more prevalent in the United States, particularly among African Americans and Latinos. Bariatric surgery has become one of the primary treatment modalities for obesity and type 2 diabetes. However, fewer Latinos and African Americans undergo bariatric surgery than whites. The objective of this article is to describe disparities in the search and access to bariatric surgery, describe the results after bariatric procedures in Latinos and African Americans, and offer recommendations and future research instructions that can help address these disparities. Methods: Original research and review articles published in English were reviewed. Results: Possible reasons are described why Latinos and African Americans have low bariatric surgery search rates. Disparities in access to care and financial coverage, low referral rates of primary care providers, and cultural attitudes toward obesity along with mistrust in the health care system are discussed as potential contributors to the low rate of bariatric surgery in Latinos and African Americans. Finally, the disparities in the results of bariatric surgery, comorbidities and complications are reviewed. Conclusions: Additional research studies on bariatric surgical disparities are needed. Recommendations and future directions that may help reduce disparities in bariatric surgery are discussed.