History of Bariatric Surgery

Obesity is a complex but growing worldwide epidemic where an individual generates an excess amount of fat in their body.[1] A person is classified as obese when their BMI or Body Mass Index exceeds 30.[2] Obesity itself can be further classified into three categories:

• Class I obesity are for patients with a BMI between 30 and 35
• Class II obesity are for patients with a BMI between 35 and 40
• Class III obesity are for patients with a BMI that exceeds 40[3]

Patients categorized into Class II and III obesity are considered severely obese and will often require surgical assistance known as bariatric surgery to lose the excess weight as dieting and exercise alone has proven to be insufficient.

Bariatric surgery is a surgical specialty designed to combat the effects of obesity on the body by making changes to the patient’s digestive system – this is done by shrinking the size of the patient’s stomach so they consume less food and drink; filling up a portion of the patient’s stomach with a medical device to create a sense of fullness faster; or changing the patient’s small intestine, which is an organ responsible for absorbing calories and nutrients.[4]

According to historians, the first mentioned of bariatric surgery date back to the 10^th century in Spain where the King of Leon, D. Sancho was reportedly so obese that he could not walk, ride a horse or wield a sword.[5] As a result, he was usurped from his throne and taken to Cordoba, a city in southern Spain by his grandmother to be treated by Hasdai Ibn Shaprut, a famous Jewish doctor.[6]

Shaprut’s unorthodox treatment for D. Sancho’s obesity included suturing the king’s lips shut and feeding him a liquid diet of teriaca, which is a mixture of herbs and opium as a side effect of opium included weight loss.[7] It was reported that under this treatment D. Sancho lost half of his weight and managed to return back to Leon on his horse to reclaim his rightful place on the throne.[8]

Aside from this account, interventions and treatments for overweight individuals remained obscure and scattered until the 1990s, when obesity was beginning to emerge as an epidemic causing the medical community to take note and start considering surgical options in order to combat it.[9]

The first surgical procedure designed to specifically tackle weight loss occurred in the 1950s at the University of Minnesota where the jejunoileal bypass (JIB) was introduced to induce in a patient, a state of malabsorption by bypassing most of the intestines while still keeping the stomach intact.[10] While the surgery did promote weight loss, the side effects patients experienced – diarrhea, night blindness, osteoporosis, kidney stones – resulted in many asking for the procedure to be reversed; and now JIB is no longer considered a recommended bariatric surgical procedure.[11]

In the 1960s, Drs. Msaon and Ito developed the gastric bypass based on findings of weight loss observed in patients who underwent partial stomach removal for ulcers.[12] Proven to be successful with minimum side effects, the gastric bypass became a staple bariatric surgical procedure that is still used today.

Nowadays, the combination of modern medicine and advanced technology have provided the fodder and ability for doctors and surgeons to expand bariatric medical procedures to include the LAP-BAND, duodenal switch, vertical banded gastroplasty and the gastric balloon. A surgeon or doctor may recommend one over the other depending on the needs of the patient.