Bariatric Surgery and Metabolic Interventions
Summary
Bariatric surgery and metabolic interventions encompass a spectrum of surgical and minimally invasive procedures designed to achieve significant and sustained weight loss while improving obesity-related metabolic disorders. Core surgical techniques include sleeve gastrectomy, Roux-en-Y gastric bypass and adjustable gastric banding, each altering gastrointestinal anatomy to restrict intake, modify nutrient absorption and evoke favourable hormonal changes. The advent of endoscopic bariatric therapies offers less invasive alternatives that reduce perioperative risk and shorten recovery, although long-term efficacy and durability vary. Enhanced recovery protocols and guideline-driven care pathways have standardised perioperative nutrition, analgesia and mobilisaton, leading to reductions in complications and hospital stay. Hormonal shifts in ghrelin, glucagon-like peptide-1 and peptide YY play a central role in appetite suppression and improved glycaemic control, underpinning both surgical and emerging pharmacological strategies. Global practice patterns show a predominance of sleeve gastrectomy, reflecting its relative simplicity and robust outcomes. Despite overall success, weight regain, nutritional deficiencies and surgical revisions remain challenges, highlighting the need for multidisciplinary teams encompassing surgical, medical, nutritional and psychological expertise. Ongoing research aims to refine patient selection, innovate less invasive modalities and integrate personalised approaches to optimise metabolic health and quality of life.
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Bariatric Surgery and Metabolic Interventions publication trend
The graph below shows the total number of articles in bariatric surgery and metabolic interventions across all publications each year (not limited to Nature Index journals).
Technical terms
Bariatric surgery: Surgical procedures that induce weight loss by altering the anatomy of the gastrointestinal tract.
Sleeve gastrectomy: Resection of a large portion of the stomach to create a narrow gastric tube, reducing food capacity and modifying appetite hormones.
Roux-en-Y gastric bypass: Creation of a small stomach pouch connected directly to the jejunum, bypassing the upper small intestine to restrict intake and alter nutrient absorption.
Endoscopic bariatric therapy: Minimally invasive, device-based interventions delivered through an endoscope to reduce gastric volume or delay gastric emptying without external incisions.
Type 2 diabetes remission: Sustained normalisation of blood glucose levels without the use of antidiabetic medications following weight-loss intervention.
References
- Clinical Applications of Endoscopic Bariatric Therapies: Potential and Pitfalls. Gastroenterology (2023).
- Bariatric Surgery and Endoluminal Procedures: IFSO Worldwide Survey 2014. Obesity Surgery (2017).
- Metabolic and Hormonal Changes After Laparoscopic Roux-en-Y Gastric Bypass and Sleeve Gastrectomy: a Randomized, Prospective Trial. Obesity Surgery (2012).
- Comparing the 5-Year Diabetes Outcomes of Sleeve Gastrectomy and Gastric Bypass. JAMA Surgery (2020).
- Weight Regain and Insufficient Weight Loss After Bariatric Surgery: Definitions, Prevalence, Mechanisms, Predictors, Prevention and Management Strategies, and Knowledge Gaps—a Scoping Review. Obesity Surgery (2021).
- Guidelines for Perioperative Care in Bariatric Surgery: Enhanced Recovery After Surgery (ERAS) Society Recommendations: A 2021 Update. World Journal of Surgery (2022).
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