What do I do with my morbidly obese patient? A detailed case study of bariatric surgery in kaiser permanente southern california

Abstract

Unfortunately, many of the traditional methods for weight loss, such as dietary restriction, exercise, meal replacement, psychosocial and behavioral interventions, and medications, have limited effectiveness in long-term weight maintenance and regulation of chronic diseases such as type 2 diabetes. This has led to the development of surgical approaches to weight loss, generally referred to as bariatric surgery. Most bariatric surgery studies have shown excellent weight-loss rates for up to two years after surgery, with patients losing an average of 61 % of their excess weight (losing 100% of excess weight would return patients to their ideal weight). There is also some evidence that most patients maintain some level of weight loss for up to ten years after surgery. The purpose of this article is to provide primary care physicians and other clinicians with some background regarding bariatric surgical procedures and their risks and benefits. We also summarize the bariatric surgery process at Kaiser Permanente Southern California (KPSC), and then provide a detailed case study as an example of how KPSC screens patients referred for surgery, prepares them for the surgery, and cares for them once they have undergone surgery.

“Mystery Valley” photograph By Eric Brody, MD