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Bariatric surgery patients need care for a lifetime

These patients face medical and psychosocial challenges that require treatment for years, and it's after the operation when the hard work begins.

By Victoria Stagg Elliott, amednews staff. June 28, 2004.

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Alan Wittgrove, MD, president of the American Society for Bariatric Surgery, wants to talk to primary care physicians.

For years, he has been giving lectures to surgeons about his craft and how to care for patients who have undergone surgical weight-loss procedures. Increasingly, however, he's thinking that he should be seeking out an additional audience.

"The group that I really should be talking to is the family practice society," said Dr. Wittgrove, who is also the medical director of the Alvarado Center for Surgical Weight Loss in San Diego.

He's part of a growing group who recognize that the emergence of bariatric surgery from a handful of procedures in the 1950s to the 140,000 projected this year means that an ever-larger number of primary care physicians will see some of these patients in their practice. And their care will continue long after the bariatric surgeons have finished their work.

"As a primary care physician, you do see a lot of obesity, and there's a certain percentage of that population that benefits substantially from the bypass surgery," said Kim Pierce, MD, an internist at Magee-Women's Hospital in Pittsburgh. "But they are medically different people post-surgery. The numbers are going to escalate, and it's going be a problem if primary care physicians aren't up on the medical management."

Little has been written on the subject, and existing bariatric surgery guidelines focus more on who is an appropriate candidate than what happens after the procedure. But many experts say the involvement of primary care physicians is key.