Metabolic & Bariatric Surgery

• 100lbs over ideal body weight
• twice ideal body weight
• or BMI of 40kg/m2 or greater

a 28-amino acid orexigenic peptide hormone

• predominantly secreted by the oxyntic glands of the proximal part of the stomach
• also produced to a lesser extent by the bowel, pancreas, and hypothalamus

causes release of growth hormone and increases the insulin signaling mechanism

Ghrelin increased by weight loss & caloric restriction

Ghrelin decreased after gastric bypass

very-low-calorie, restriction of fat or carbohydrate intake

Sibutramine - blocks the presynaptic uptake of norepinephrine & serotonin thereby potentiating their anorexic effect in the CNS

Orlistat - inhibits pancreatic lipase thereby reducing the absorption of up to 30% of ingested fat

For severely obese patients, neither med has shown promising long-term weight loss

• BMI > 40kg/m2 without associated comorbidity
• or BMI 35kg/m2 or greater with comorbidity

• and:
• failed nonoperative weight loss attempts
• psychiatrically stable without substance abuse
• knowledge of the operation & sequelae
• medically safe to undergo surgery