Medical and surgical options in the treatment of severe obesity

Abstract

Weight loss programs, diets, and drug therapy have not shown long-term effectiveness in treating morbid obesity. A 1992 statement from the National Institutes of Health Consensus Development Conference affirmed the superiority of surgical over nonsurgical approaches to this condition. Bariatric surgical procedures work in 1 of 2 ways: by restricting a patient's ability to eat (restrictive procedures) or by interfering with ingested nutrient absorption (malabsorptive procedures). Many of these procedures can be performed by a laparoscopic approach, which has been shown to reduce operative morbidity. In the United States, the primary operative choice for morbidly obese patients has recently shifted from vertical banded gastroplasty (VBG) to the Roux-en-Y gastric bypass (RYGBP). VBG, a purely restrictive procedure, has fallen into disfavor because of inadequate long-term weight loss. RYGBP combines restriction and malabsorption principles, and has been shown to induce greater weight loss than VBG. Other procedures currently being offered include laparoscopic adjustable gastric banding; biliopancreatic diversion (BPD), including the duodenal switch (BPD-DS) variation; and distal gastric bypass (DGBP). The problem of obesity has reached epidemic proportions in the United States. More than 50% of adults are obese or overweight, and 5% are severely obese (body mass index [BMI] of Ն35) [1]. Numerous studies have demonstrated a strong relation between BMI and the development of lifeimpairing comorbidities, such as hypertension, diabetes (type 2), atherosclerosis, sleep apnea, and osteoarthritis. Obesity is associated with a higher risk of cancer (breast, colon, uterine) and premature death. Patients with severe or morbid obesity (BMI Ͼ35), the focus of this review, are consequently most severely affected by the disease, have a poor quality of life, and thus have the greatest need for weight loss therapy. Numerous medical and surgical treatments for severe obesity have come and gone over the years, underscoring the challenge and complexity of obesity management. The intent of this review is to summarize the current status of medical and surgical options for the treatment of severe obesity. Management of obesity

Bariatric surgery and bone disease: from clinical perspective to molecular insights

“…They can be divided into two general categories: restrictive procedures (i.e., adjustable gastric banding and sleeve gastrectomy) and malabsorptive procedures with or without restrictive components (i.e., biliopancreatic diversion, duodenal switch and Roux-Y-gastric bypass. 8 ) The efficacy and safety profiles among these categories vary substantially as a result of differences in the anatomic configurations produced and the alterations in gastrointestinal physiology that are created by the different surgical procedures. Whichever method is used, numerous short-and medium-term studies have confirmed that bariatric surgery is superior to conventional, non-operative methods in inducing weight loss and resolving comorbidities.…”

Complications associated with adjustable gastric banding for morbid obesity: a surgeon's guide

“…2 Nonsurgical management of obesity includes dietary changes and exercise, which can facilitate a 5%-10% weight loss. [3][4][5] Unfortunately, once patients stop a weight loss program, weight gain typically occurs.…”

The economic impact of morbid obesity

“…Some, but not all, studies show that obesity lowers wages [26,27]. In terms of productivity, recent papers have shown that the cost of obesity among full-time employees is highly concentrated among those eligible for bariatric surgery, which is only one-third of the obese population; that there is increased work loss by the patients who are surgically ineligible; and that in less than 4 years, bariatric surgery yields a net economic gain.…”