Obesity is a complex medical condition associated with a great variety of complications which affect most organs through different pathways. There is now considerable evidence that intentional weight loss due to bariatric surgery is linked to clinically relevant benefits for the majority of these health issues.

• First of all, significant weight loss has a positive impact on one’s blood pressure, notably improves cardiac function and reduces risk of cardiovascular events.
• Moreover, it is consistently associated with a clinically relevant reduction in triglycerides and increase in HDL cholesterol, also known as “good” cholesterol.

• Metabolic surgery may be particularly suitable for patients with type 2 diabetes, as these patients may benefit from improved glycaemic control compared to patients treated with medications alone.
• In addition, obesity is widely recognized as a key modifiable risk factor for osteoarthritis, with significant improvements in pain and function reported with weight loss.
• Obstructive sleep apnoea and obesity hypoventilation syndrome tend to improve even when a moderate amount of weight is lost.
• It is worth mentioning that sustained weight loss seems to be associated with a significant improvement in asthma symptoms, too.

Last but not least, several studies suggest that long-term weight loss not only improves health-related quality of life, but also has a very positive effect on a patient’s self-esteem and so a more positive self-image can be built

• BMI :

  The most important patient selection criteria for bariatric surgery include body mass index (BMI), the presence of co-morbidities and a history of prior weight loss attempts. Bariatric surgery is advised when BMI ranges from 35 to 40 and there are obesity related conditions such as diabetes or obstructive sleep apnoea, or when BMI is 40 or greater regardless of weight related co-morbidities.

Overall health:

However, an individualized pre-operative assessment is a complex process involving psychological, surgical, dietetic and medical review because benefits of the procedure should outweigh the operative risk for every patient.

Patient's compliance :

It is worth emphasizing that the long-term success of bariatric procedures is critically dependent on patients’ compliance. In order to properly evaluate whether a candidate could make lifelong behaviour changes necessary for sustained weight loss, one must be not only physically, but also psychologically fit to proceed with surgery.

Medical conditions :

A few pre-existing medical conditions represent absolute contraindications to bariatric surgery. Notable exceptions are unstable coronary artery disease or an advanced liver disease with portal hypertension.

A successful weight-loss outcome after bariatric surgery has been defined as a loss of at least 50% of excess weight.

To assess motivation and predict compliance to postsurgical recommendations, it is advised for patients to lose some weight before surgery. Moreover, psychotropic medications, such as antidepressants, are considered to very likely promote weight gain in post-operative patients.

Lifestyle changes after bariatric surgery :

Food  :

Patients should follow prescribed serving sizes to avoid overeating. Food should be well-chewed and consumed very slowly. Liquids should not be consumed with solid foods.

Supplements :

Moreover, frequent monitoring of nutritional status and additional supplementation, as needed, can aid in preventing severe clinical deficiencies.

Activity :

Physical activity plays an essential role in weight loss maintenance after a dietary intervention. Several weight loss studies have shown a clear dose response between physical activity and prevention of weight regain.

For a more profound understanding about bariatric surgery its risks should be assessed along with the significant benefits. Postoperative gastrointestinal complications of bariatric surgery are common.

Nausea and vomiting :

Nausea and vomiting occur in more than 50% of patients undergoing restrictive procedures, partly as a result of eating too much or too rapidly but sometimes because of anastomotic stricture or other mechanical consequences of the operation.

The dumping syndrome:

The dumping syndrome, a complex of neurohormonally mediated symptoms that include facial flushing, lightheadedness, palpitations, fatigue, and diarrhoea, occurs in some patients after Roux-en-Y gastric bypass. Typically triggered by the ingestion of concentrated sugar, this syndrome may discourage patients from eating foods with a high sugar content, thus contributing to the beneficial effects of the operation.

Deficience of nutrients:

Deficiencies of iron, calcium, folate, vitamin B12, and other nutrients occur after procedures with a component of malabsorption, such as gastric bypass. With the more extensive procedures, such as biliopancreatic diversion, protein malnutrition and deficiencies of the fat-soluble vitamins (A, D, E, and K) may occur. All of these deficiencies require regular monitoring and replacement.

Other gastrointestinal complications:

Other gastrointestinal complications include dehydration, bowel obstruction, anastomotic leaks, strictures, erosions, ulcers, adhesions, internal and incisional hernias, and cholelithiasis.

Anastomotic leakage :

In addition, studies have shown that the most serious surgical complication of the commonly performed bariatric surgeries, such as gastric bypass, is anastomotic leakage which may potentially lead to life-threatening peritonitis.

All things considered, patients at a higher risk for perioperative and postoperative complications are males, smokers, and those with higher BMI, older age or multiple comorbidities.

Right preparation for bariatric surgery is a vital part of the procedure itself as it determines the success of the operation and the quality of recovery after it.

Practice healthy lifestyle. Exercising regularly, having your diet balanced and staying hydrated will strengthen your body and recovery after the surgery will be faster.

• Avoid using tobacco products and consuming alcohol at least 1 month before the procedure.
• In order to prevent perioperative complications, taking aspirin, anti-inflammatory drugs and other blood thinners should be avoided at least 2 weeks before the procedure, unless the operating doctor has advised otherwise.
• Consult the surgeon about your allergies, previous surgeries and daily medications. If you have any pre-existing conditions that require daily usage of drugs, your operating doctor should be informed about it.
• Follow your specific pre-operative instructions as they may vary depending on your personal medical history.