What is the treatment for a large abdominal apron due to significant weight gain?

Treatment Options for Large Abdominal Pannus

For patients with a large abdominal pannus (apron) causing significant weight gain, a comprehensive approach including lifestyle modifications, pharmacotherapy, and surgical intervention is recommended, with bariatric surgery being the most effective treatment option for severe cases.

Initial Assessment and Non-Surgical Management

• The first step is medical evaluation to determine BMI, waist circumference, and identify obesity-related health risks and complications 1
• For patients with BMI ≥30 kg/m² or BMI ≥27 kg/m² with weight-related complications, a structured weight loss program should be initiated 1
• Core components of non-surgical management include:
  • Dietary intervention with caloric deficit of 500-1000 kcal/day, aiming for 1-2 pounds weight loss per week 1
  • Regular physical activity with minimum 150 minutes of moderate weekly activity 2
  • Behavioral modification therapy to support lifestyle changes 1
• Pharmacotherapy should be considered as an adjunct to lifestyle interventions when lifestyle changes alone are insufficient 1
  • Medications approved for long-term weight management include orlistat, naltrexone/bupropion, liraglutide, and in the US, lorcaserin and phentermine/topiramate 2
  • Pharmacotherapy should only be continued if at least 5% of initial body weight is lost during the first 3 months 1

Surgical Management Options

• Bariatric surgery is the most effective treatment for severe obesity and should be considered when 1:

  • BMI ≥40 kg/m² regardless of previous conservative interventions
  • BMI ≥35 kg/m² with weight-related complications after failed non-surgical interventions
  • BMI 30-34.9 kg/m² with metabolic disease (particularly diabetes)

• Common bariatric surgical procedures include 1, 3:

  • Laparoscopic sleeve gastrectomy (LSG): Removes approximately 85% of the stomach
  • Roux-en-Y gastric bypass (RYGB): Creates small gastric pouch connected directly to jejunum
  • Expected weight loss is approximately 25% after LSG and 30% after RYGB at 12 months 1

• For patients specifically with a large abdominal pannus (apron), panniculectomy may be indicated when 4, 5:

  • The pannus causes functional limitations
  • Local complications are present (skin infections, panniculitis, ulcerations)
  • Quality of life is significantly impacted

• Panniculectomy involves surgical removal of the excess abdominal skin and fat (pannus) and can result in significant improvements in mobility, hygiene, and quality of life 5

Post-Surgical Considerations

• Long-term multidisciplinary follow-up care is essential after bariatric surgery, typically for at least 2 years 1
• Regular monitoring should include 1:
  • Dietetic and micronutrient assessment
  • Individualized nutritional supplementation
  • Psychological support
• Weight regain can occur in some patients post-bariatric surgery due to multiple factors 6:
  • Patient-specific factors (psychiatric issues, physical inactivity, dietary non-compliance)
  • Procedure-specific factors
  • Addressing weight regain requires systematic assessment of contributing dietary, psychological, medical, and surgical factors 6

Potential Complications and Considerations

• Bariatric surgery complications may include anastomotic leaks, stenosis, bleeding, and venous thromboembolism 1
• Panniculectomy for giant pannus carries risks including bleeding requiring transfusion and wound complications 5
• Despite risks, carefully selected patients with a large pannus can experience dramatically improved quality of life following panniculectomy 5
• Post-panniculectomy, many patients report additional weight loss, increased exercise ability, and improved mobility 5