Bariatric surgery as an effective method of fighting morbid obesity

Based on the definition of obesity as a chronic, recurrent disease characterized by excessive deposition of adipose tissue in the body, the low effectiveness of treatment becomes obvious and conceivable. In 95% of cases it is not possible to reduce body weight for a long period of time, and a significant part of patients tend to return to the initial body weight already in the first year after therapy termination.

When all diets, psychotherapy and other attempts, including drug treatment, do not provide a specific positive result, bariatric surgery methods come to the rescue of the doctor and the patient.

To date, bariatric surgery has been recognized as the most effective and radical method of treating morbid obesity. Bariatric surgery can secure impressive results in terms of weight loss and improved health outcomes for patients. This type of surgery has gained widespread use today, and the number of surgeries and experts in this field is growing every year.

Indications for surgical treatment of obesity are BMI≥40 kg/m2 or BMI ≥35 kg/m2 in the presence of diseases that can be affected by a decrease in BW. Bariatric surgery is indicated for patients aged 18 to 60.
General principles for the treatment of obesity
Some authors even call bariatric surgery the "gold" standard for the treatment of morbid obesity, highlighting the effectiveness of this method, including in patients with compensated cirrhosis. Other authors consider this method of treatment as the first step toward improving metabolic processes and remission of type 2 diabetes mellitus.
Types of bariatric surgeries
Sleeve Gastrectomy (SG)
Adjustable GastricBand (AGB)
Roux-en-Y Gastric Bypass (RYGB)
Duodenal Switch (DS)
Impartiality and objectivity with respect to this type of operation can be demonstrated by the recent review from 2016 "Mortality from all causes and causes associated with bariatric surgery." The review explains that since the first study published – MacDonald et al in 1997 – which described the reporting of long-term mortality associated with bariatric surgery, there have been at least 28 studies that look at mortality rates at least 2 years after bariatric surgery. Based on numerous studies discussing long-term mortality after bariatric surgery, the following conclusions have been made. In patients after bariatric surgery: 1) long-term mortality from all causes is significantly reduced compared with morbid obesity in the control arm without bariatric interventions; 2) there is an increase in mortality compared to the general population, with the exception of one study; 3) a decrease in mortality from cardiovascular diseases, stroke, cancer was found compared with morbid obesity in the control arm of patients without surgery; 4) an increased risk from external causes of death such as suicide was identified. An exact causal relationship between bariatric surgery and increased mortality compared with the control arm has not been established.

Let us speculate about the reasons for such a high mortality rate as a result of external causes, such as suicide. Firstly, bariatric interventions cannot guarantee stable and consistent weight loss, as well as the abolition of morbid obesity complications. Secondly, a psychiatrist's consultation is an obligatory part of the patient's preoperative preparation, but at the same time, it is voluntary, i.e. at the patient’s discretion. The obligation to consult a psychiatrist is clearly indicated in the Clinical Guidelines for the Morbid Obesity Treatment in Adults (2016), however, in more modern Algorithms for Specialized Medical Care for Diabetes Mellitus Patients (2017), there is not even a mention of it, or the psychiatrist is meant in the wording "... and other healthcare professionals." The importance of psychiatric consultation in such patients cannot be overemphasized, since a significant number of mental disorders are contraindications for such surgery.

Thirdly, a patient who has undergone bariatric surgery has a long and difficult path ahead, where the development of micronutrient pathology, non-alcoholic fatty liver disease, osteopenia and osteoporosis, gastroesophageal reflux, B12-deficiency anemia, and other diseases are not apparent, but quite real without adequate monitoring and timely treatment. A step-by-step algorithm for observation, timely correction of diselementosis and other pathologies, as well as adequate diet therapy, which is LIFETIME in nature, are described in sufficient detail in the Clinical Guidelines for the Morbid Obesity Treatment in Adults (2016) and the Russian Clinical Guidelines for Endocrinology (2018).

Despite the fact that all obese patients who have undergone bariatric surgery need vitamin and mineral support, there are currently no vitamin & mineral complexes on the Russian pharmaceutical market that would fully satisfy the daily needs of these patients in vitamins and micronutrients. So, it makes the prevention of long-term postoperative complications quite challenging. In this context, doctors have to combine the prescription of multivitamins available in the pharmacy network, iron, calcium and vitamin D formulations, and fat-soluble vitamins in order to achieve optimal daily doses for patients after various bariatric surgeries. This leads to inconveniences because to secure optimal doses of vitamins, macro- and micronutrients, patients have to simultaneously take a large number of medicines (up to 10 tablets or capsules per day). The result is a violation of adherence to treatment (compliance), partial or complete skipping of the dose and excessive expenses for purchasing medicines, as well as the inevitable increase in postoperative complications caused by metabolic disorders.

The development and launching on the Russian pharmaceutical market of vitamin & mineral supplements well-balanced in all necessary components and meeting the recommended daily needs of patients after bariatric surgery would reduce the rates of long-term metabolic disorders by increasing compliance, facilitating administration and reducing the expenses for purchasing the medicine. Therefore, pharmaceutical companies are faced with the task of developing domestic vitamin & mineral complexes that would meet the needs of patients after bariatric surgery and at the same time combine ease of use and affordability. Currently, such special vitamin & mineral formulations have already been developed and are described on this website.
  1. Treatment of obesity and metabolic syndrome: diet therapy and pharmacotherapy / textbook for doctors / M.L. Maksimov, V.A. Dudareva et al. – Kazan: Publishing house "MedDoc", 2020. - p. 56
  2. Clinical pharmacology and rational pharmacotherapy for practitioners: textbook / M.L. Maksimov, R.A. Bontsevich, I.S. Burashnikova [et al.]; ed. Prof. M.L. Maksimov. – Kazan: Publishing house "MedDoc", 2021. - p. 948 ISBN 978-5-6045764-9-6;
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