Critical assessment of the current guidelines for the management and treatment of morbidly obese patients

Abstract

An interdisciplinary panel of specialists met in Mallorca in the first European Symposium on Morbid Obesity entitled; "Morbid Obesity, an Interdisciplinary Approach". During the two and half days of the meeting, the participants discussed several aspects related to pathogenesis, evaluation, and treatment of morbid obesity. The expert panel included basic research scientists, dietitians and nutritionists, exercise physiologists, endocrinologists, psychiatrists, cardiologists, pneumonologists, anesthesiologists, and bariatric surgeons with expertise in the different weight loss surgeries. The symposium was sponsored by the Balearic Islands Health Department; however, this statement is an independent report of the panel and is not a policy statement of any of the sponsors or endorsers of the Symposium. The prevalence of morbid obesity, the most severe state of the disease, has become epidemic. The current recommendations for the therapy of the morbidly obese comes as a result of a National Institutes of Health (NIH) Consensus Conference held in 1991 and subsequently reviewed in 2004 by the American Society for Bariatric Surgery. This document reviews the work-up evaluation of the morbidly obese patient, the current status of the indications for bariatric surgery and which type of procedure should be recommended; it also brings up for discussion some important real-life clinical practice issues, which should be taken into consideration when evaluating and treating morbidly obese patients. Finally, it also goes through current scientific evidence supporting the potential effectiveness of medical therapy as treatment of patients with morbid obesity.

Graft Survival and Complications after Laparoscopic Gastric Banding for Morbid Obesity—Lessons Learned from a 12-Year Experience

“…Studies show that nonsurgical treatment options for obesity, including diet plans, behavioral modifications, exercise, and pharmacologic agents, rarely lead to more than 5% to 10% reduction of excess weight; usually more than 95% of the patients regain their weight within 5 years [37]. Thus, bariatric surgery is the only effective and sustained treatment for morbid obesity resulting in long-term weight loss, improved lifestyle, and amelioration of co-morbid risk factors [3,[6][7][8][37][38][39][40][41]. In fact, the practice of bariatric surgery has increased more than 10-fold in the USA between 1994 and 2005.…”

Recent advances in the modification of taste and food preferences following bariatric surgery

“…In 2004, the initial guidelines were updated by a Consensus Conference which expanded the types of operative procedures and recommended considering bariatric surgery in patients with Class I obesity (BMI 30 to 34.9 kg/m 2 ) [16,17]. Given the increased need and evolving techniques for bariatric surgery as a treatment for obesity, it is likely these clinical practice guidelines will continue to undergo review and revision.…”

“…As many conditions preclude the use of bariatric surgery [16], exclusion criteria should be evaluated in the pre-surgical assessment. Conditions in which bariatric surgery should not be considered include: the inability to maintain weight loss with conventional therapy, severe cardiac disease with unreasonable anesthetic risks for complications, active substance abuse, severe coagulopathy, uncontrolled and untreated eating disorders, untreated major depression or psychosis, and socially disruptive personality disorders.…”

The Impact of Obesity on Long-term Survival After Coronary Artery Bypass Grafting

“…Currently, the National Institutes of Health recommend bariatric surgery for patients who are morbidly obese (BMI 40 kg/m 2 , or BMI 35 kg/m 2 with other serious comorbidities such as diabetes or CAD) [28]. Bariatric surgery has been shown to physiologically cure diabetes and improve long-term survival in morbidly obese patients [23,29].…”