Introduction
Weight loss surgery can have a tremendous effect on the health of the bones. Nowadays, many adult patients are undergoing weight loss surgery to manage obesity. The American Society of Metabolic and Bariatric Surgery recommends early surgical intervention in people with severe obesity to avoid the development of comorbidities due to increased weight. The most common surgeries that are performed for weight loss are sleeve gastrectomy and Roux-en-y-gastric bypass surgery (RYGB). These surgeries have proven to be effective in the management of weight loss and in preventing the comorbidities associated with obesity. However, with increasing age, there is a tremendous loss of bone minerals in adults, resulting in an alteration in bone mass and density. Compromised bone health in adults due to reduced bone density can have a greater impact on bone health due to weight loss surgeries.
What Are the Risks Associated With Weight Loss Surgery in Adults?
There are numerous risks to the bone health of adult patients undergoing weight loss surgery, such as:
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Reduction in bone strength.
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Alteration in bone structure.
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Increase bone marrow adiposity (increase in the adipose tissue in the medullary canals of the bone).
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Increase the risk of bone fractures.
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Disturbance in hormonal secretions required for bone health.
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May cause worsening of co-existing systemic conditions like diabetes and metabolic disorders.
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Nutritional deficiencies after the surgery, such as calcium and phosphorus deficiency, might occur due to malabsorption of food and reduced food intake after the surgery.
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Life-long systemic disorders might occur after the surgery, such as type 2 diabetes, high blood pressure, high cholesterol levels, increased risk of cardiac diseases, etc.
What Are the Guidelines for Weight Loss Surgery in Adult Patients by the American Society of Bariatric and Metabolic Surgery?
According to the ABMS (American Society of Bariatric and Metabolic Surgery), there are some guidelines for selecting the ideal adult candidate for weight loss surgery. A few guidelines from the ABMS are:
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Adults with a BMI (Body Mass Index) of more than 140 percent.
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Adults with a body mass index (BMI) of more than 120 percentile and also having associated existing systemic diseases like diabetes, hyperlipidemia (high lipids levels), hypertension, fatty liver, bone disorders, obstructive sleep apnea, etc.
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Patients who have not undergone pharmacological therapy and lifestyle changes for the management of weight loss as initial therapy are not considered for weight loss surgery directly according to the guidelines.
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Patients with obesity due to associated hereditary syndromes are not considered for weight loss surgeries, as there is still a controversy ongoing regarding the outcome and impact of weight loss surgery in such patients. Further research is needed to study the impact of weight loss surgeries in patients with a hereditary syndrome such as Prader-Willi syndrome (a genetic disorder causing obesity).
All the above guidelines should be implemented for shortlisting the ideal adult candidates for weight loss surgeries. The multidisciplinary team approach should be followed before, during, and after the surgery, along with maintaining nutritional, pharmacological, and behavioral support.
What Are Different Weight Loss Surgeries and Their Impact on Bone Health in Adult Patients?
Different weight loss surgeries performed by surgeons to achieve an adequate amount of weight loss in obese patients are:
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Sleeve Gastrectomy: Sleeve gastrectomy is a widely used weight loss surgical procedure surgeons perform. A large amount of abdominal fat or stomach portion is removed in this surgical procedure. Around 75 percent of the stomach portion is removed during this surgery to induce weight loss.
Effects of Sleeve Gastrectomy on Bone Health: Following sleeve gastrectomy surgical procedures, there is an increased risk of reduction in bone density, and increased bone marrow fat in the lumbar spine makes it more prone to fracture, according to the research.
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Roux-En-Y-Gastric Bypass Surgery: This surgical procedure involves the removal of a smaller portion of the stomach and the creation of a small egg-size stomach pouch. This small pouch is later connected to the middle portion of the small intestine bypassing the other stomach parts and upper portion of the small intestine.
Effects of Roux-En-Y-Gastric Bypass Surgery on Bone Health: This surgical procedure can result in severe nutritional deficiency and long-term systemic disease after the surgical procedure. This surgical procedure can result in approximately 50 to 70 percent of weight loss in adolescents within one year.
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Adjustable Gastric Banding: It is a quite technique-sensitive surgical procedure that involves the use of inflatable silicon, which is placed around the upper portion of the stomach resulting in a slowing down of food consumption. This procedure is less popular and may require revision surgery.
What Are New Emerging Therapies for Weight Loss Surgeries in Adults?
Currently, emerging therapies and clinical trials ongoing for studying the newer pharmacological weight loss surgeries in adult patients are:
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Incretin-Based Pharmacological Property: Incretin-based pharmacological therapy, like glucagon-like peptide-1 (GLP-1) therapy, is used for weight loss nowadays. Research is still ongoing to study its effectiveness in the management of obesity. Many pieces of research have shown glucagon-like peptide-1 (GLP-1) therapy effective in weight loss in adult patients.
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Semaglutide: It has shown weight loss in a few patients with obesity, according to the research.
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Glucose-Dependent Insulinotropic Polypeptide: It has proven to be a safe and effective pharmacological therapy for the management of obesity in adult patients.
All these pharmacological therapies are under trial for achieving effective weight loss in obese adult patients. Pharmacological therapy, along with lifestyle changes, should be preferred for weight loss initially before stepping into surgical intervention.
Conclusion
Obesity, or sudden weight gain, has become a problem of concern nowadays in different parts of the world. Various surgical procedures have been implemented for the management of weight loss in severely obese patients. Although these weight loss surgeries help in the reduction of the maximum amount of weight from the body by relieving the stress-bearing areas of the body in adults. However, there are various risks associated with weight loss surgeries for bone health in adults, like an increased risk of bone fractures due to a reduction in bone density and an increase in bone marrow adipose tissue. Furthermore, research and clinical trials are still needed to completely understand the negative impact of weight loss surgeries on bone health in adults.
