Coronavirus Chronicles — Bariatric Surgery and COVID-19, Continued

Although this could change, since the beginning obesity has been the biggest predictor of COVID-19 fatality. For this and other reasons, bariatric surgery has been making it through the pandemic quite satisfactorily.

Dr. Matthew Hutter of Harvard Medical School is well aware of the close entanglement between COVID-19 and obesity, and is able to articulate how the medical profession has coped with the challenge. Since a large part of bariatric surgery is preparation and another large part is maintenance, this type of intervention is very amenable to the telehealth format. Even the pre-surgical sitdowns with the anesthesiologist and the pre-admission testing can be conducted remotely. The stay is short — “When patients come to the hospital, they are tested within 72 hours before surgery to ensure they are COVID-19 free […] and they go home the next day after surgery.”

The ability to follow patients remotely is priceless. In a way that is atypical of most disease processes, fending off obesity is a long-term proposition. With a “completely virtual option,” as long as both sides fulfill their obligations, it seems to work. Dr. Hutter speaks of the advantages of being “almost 100% telehealth”:

We have more focused discussions, and we’re able to have more frequent meetings as people don’t have to worry about things like daycare, parking or driving into Boston.

Of course, anything can be argued, but this sounds like a collection of best practices. If there must be such a thing as bariatric surgery, this is very likely how it should be done.

A paper published by a government website in February outlined why obesity worsens the virus. The weakened lungs labor extra hard just to push the excess weight around while inhaling and exhaling. Also, obesity often travels in company with type 2 diabetes, hypertension, cardiovascular disease, atherosclerosis, and even cancer. Then, there are the hypercoagulopathy and hyperinflammation often associated with obesity. COVID also promotes blood clotting, and having two different conditions that both do so is not recommended.

This work also pointed out that, on top of the usual difficulties in adhering to the program, pandemic anxiety contributes to “increased emotional distress and difficulty adhering to healthy lifestyle changes post-surgery.” In conclusion:

This study showed that the COVID-19 pandemic has impacted patients’ ability to self-manage obesity and their mental health in a variety of ways. These findings suggest that patients may experience unique psychological distress and challenges requiring personalized care strategies to improve obesity self-care and overall well-being.

Another angle is presented by Sage Publishing, which said in April of this year,

The global COVID-19 pandemic has resulted in the widespread suspension of bariatric surgical programs.

While the writer acknowledges that cutting back was initially necessary, caution has to be weighed against “the implications of delaying the most effective treatment for weight loss in a population at risk from this crisis.” In other words, do the benefits outweigh the risks?

The conclusion is,

From the patient’s perspective, postponing surgery has been deleterious and efforts to safely reintroduce bariatric programs should be promoted.

Your responses and feedback are welcome!

Source: “Bariatric Surgery in the Time of COVID-19,” MassGeneral.org 01/08/21
Source: “The impact of COVID-19 pandemic on bariatric patients’ self-management post-surgery,” NIH.gov, 02/19/21
Source: “Serious Impacts of Postponing Bariatric Surgery as a Result of the COVID-19 Pandemic: The Patient Perspective,” SagePub.com. 04/07/21
Image by Daniel Lobo/Public Domain

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Profiles: Kids Struggling with Weight

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The Book

OVERWEIGHT: What Kids Say explores the obesity problem from the often-overlooked perspective of children struggling with being overweight.

About Dr. Robert A. Pretlow

Dr. Robert A. Pretlow is a pediatrician and childhood obesity specialist. He has been researching and spreading awareness on the childhood obesity epidemic in the US for more than a decade.
You can contact Dr. Pretlow at:

Presentations

Dr. Pretlow’s invited presentation at the American Society of Animal Science 2020 Conference
What’s Causing Obesity in Companion Animals and What Can We Do About It

Dr. Pretlow’s invited presentation at the World Obesity Federation 2019 Conference:
Food/Eating Addiction and the Displacement Mechanism

Dr. Pretlow’s Multi-Center Clinical Trial Kick-off Speech 2018:
Obesity: Tackling the Root Cause

Dr. Pretlow’s 2017 Workshop on
Treatment of Obesity Using the Addiction Model

Dr. Pretlow’s invited presentation for
TEC and UNC 2016

Dr. Pretlow’s invited presentation at the 2015 Obesity Summit in London, UK.

Dr. Pretlow’s invited keynote at the 2014 European Childhood Obesity Group Congress in Salzburg, Austria.

Dr. Pretlow’s presentation at the 2013 European Congress on Obesity in Liverpool, UK.

Dr. Pretlow’s presentation at the 2011 International Conference on Childhood Obesity in Lisbon, Portugal.

Dr. Pretlow’s presentation at the 2010 Uniting Against Childhood Obesity Conference in Houston, TX.

Food & Health Resources