Bariatrics originated in 1965 is rooted in the Greek words; “bar” (weight), “iatr” (treatment/surgery), and “ic” (having characteristics of). The procedures like standalone sleeve gastrectomy, RNY gastric bypass, and duodenal switch (BPD/DS) collectively make up what is known as bariatric and metabolic surgery.

Changes to the digestive tract and altering gut hormones result in improved satiety and reduced hunger. Bariatrics is a practical and potent approach versus conventional treatments in achieving sustainable weight reduction and resolving morbidities, such as cardiovascular problems, diabetes, hypertension, sleep apnea, and asthma.

Evolution of Bariatric Surgery

Treatment of Obesity in 10th Century

Historians report that the Spanish king of Leon, Sancho I (932-966), was the first patient known to be treated for obesity. Nicknamed “the Fat,” he was so huge he could not walk or pick up a sword. As a result, Sancho I lost his throne.

Sancho I was attended by a Jewish physician, Hasday Ibn Shaprut, who authored the first anti-obesity diet plan. Dr. Shaprut sewed up the overthrown king’s lips so tight that he could only drink liquid with a straw. That made him lose half of his weight and be able to reclaim his crown.

Obesity Pandemic

Growing in exponential proportion, obesity poses serious health risks and fatality worldwide. When diet and exercise are unproductive, bariatric surgery facilitates substantial weight loss. Body Mass Index, or BMI, is a conventional measurement used to calculate body fat percentage based on a person’s height and weight.

The Mechanics of Bariatric Surgery

Long-term weight loss is largely attributed to the alteration of gut hormone levels that are responsible for hunger and satiety, fundamentally leading to a new hormonal weight set point.

Bariatric weight loss surgery encompasses specialized laparoscopic, open-incision, and endoscopic techniques performed on people who are overweight, obese, or morbidly obese.

Number of Bariatric Surgeries (2011 to 2019)

201120122013201420152016201720182019*
Total158,000173,000179,000193,000196,000216,000228,000252,000256,000
Gastric Sleeve
(Vertical Sleeve Gastrectomy)
28,12457,09075,35999,781105,056125,496135,432154,728152,064
Gastric Bypass
(Roux-en-Y)
57,98664,87561,21851,72445,08040,39240,58442,84045,568
Gastric Banding
(LAP-BAND)
55,93234,94625,06018,33511,1727,3446,1562,7722,304
Duodenal Switch
(BPD/DS)
1,4221,7301,7907721,1761,2961,5962,0162,304
Revision Surgery9,48010,38010,74022,19526,65630,24032,14838,80842,752
Other5,0563,9794,8331936,2725,6165,7005,7966,144
Gastric Balloon
(Balloon Weight Loss System)
5885,6166,3845,0404,608

*Source: ASMBS – American Society of Bariatric and Metabolic Surgeries

The Future of Bariatric Surgery

Estimated Number of Gastric Sleeve, Gastric Bypass, Gastric Banding, Duodenal Switch, and Gastric Balloon Procedures Performed

Weight loss surgery has been reported to improve patients’ quality of life, psychological relief, and improved mental health. Mortality rates are negatively correlated with obesity. The underlying medical comorbidities are studied to be highly effective by significantly reducing risk factors for obese individuals.

Gastric bypass and other weight-loss surgeries like vertical sleeve gastrectomy – performed mainly laparoscopically — have proven themselves to be of great value to super obese. The future direction of bariatric surgery is Robotics and Endoscopic operations.

Robotic laparoscopic bariatric surgery

Robotics is also minimally invasive as being tested and implemented to become mainstream. Natural Orifice Transluminal Endoscopic Surgery (NOTES) and Laparoendoscopic Single-Site (or LESS) Surgery are evolving robotic techniques.

Endoscopic procedures

Endoscopic procedures, like ESG (Endoscopic Sleeve Gastrectomy), are considered less invasive operations. Endobariatrics are taking their place as an alternative to laparoscopic operations, but they are limited to lower BMIs and specific revisions.