Bariatric Procedures

Abstract

Bariatric endocrinology is a new area of focus for clinical endocrinologists. With the accumulation of fat mass (adiposity), most patients also develop adipsopathy, or adipose tissue dysfunction. Adiposopathy denotes derangements of function and structure of adipose tissue which then contribute to other metabolic disorders. The increased morbidity, mortality, and economic costs of adiposopathy, overweight, and obesity warrant aggressive treatment. In the practice of bariatric endocrinology the primary goals of treatment are to reduce fat mass to treat adiposity and its complications, and to return adipose tissue function back to normal. A century ago bariatric procedures focused entirely on reducing poundage. Now, bariatric procedures are vital in the practice of medicine. They are not just mechanical means to reduce fat mass, but rather interventions designed to revert the metabolic derangements that characterize adiposopathy. Bariatric procedures include rearrangement of the alimentary tract to restrict food entry or to produce malabsorption of calories. More recently, interventions to disrupt the neurological and humoral signaling to and from the central nervous system have been incorporated into the practice of medicine. Although bariatric procedures usually elicit weight loss as part of their mechanism of action, it is clear that metabolic improvement happens well before the pounds are shed. Therefore, metabolic improvement from bariatric procedures includes both early and late beneficial changes in the gut, adipose tissue, other hormonal systems which regulate metabolism, and the brain, where integration of signals takes place. This chapter provides a historical perspective on the evolution of bariatric procedures. It also summarizes knowledge of their effects on metabolism, including adipose tissue.