Surgical Treatment of Obesity: Who Is an Appropriate Candidate?

Abstract

The increasing prevalence and far-reaching medical, social, and economical implications of obesity have made it a national health-care crisis in the United States. About one in every three persons is at least 20% above "ideal" body weight, and approximately 5% have direct weight-related serious health problems (morbid obesity), including hypertension, hyperlipidemia, coronary artery disease, adult-onset diabetes mellitus, degenerative osteoarthropathy, and obstructive sleep apnea. Morbidly obese patients have an estimated 6- to 12-fold increase in mortality. In addition, they have a substantially diminished quality of life, not only physically but also psychosocially due to overt and occult prejudice. Weight reduction must be aggressively pursued in these patients. Medically supervised weight-control programs have been ineffective because patients cannot maintain pronounced long-term weight loss. In contrast, current operative methods have been proved to be effective in helping patients achieve and maintain permanent weight reduction. Several operations have been designed and assessed; with these procedures, weight loss is achieved by inducing malabsorption, maldigestion, early satiety, or a combination of these outcomes. Although these operations have associated side effects and limitations, the expected benefits outweigh the risks. For optimal results, patients must be carefully selected and treated by a multidisciplinary group.

Bone metabolism and risk of secondary hyperparathyroidism 12 months after gastric banding in obese pre-menopausal women

“…4 Morbid obesity is associated with significant comorbid conditions and a reduced life expectancy. 5,6 Because of the increasingly recognized fact that conservative therapy for morbid obesity is associated with an almost 100% long-term failure rate, and probably because of the development of laparoscopic surgery, the demand for bariatric surgery is expanding rapidly. Today, malabsorptive procedures and their potentially severe side effects have been replaced by restrictive operations, such as vertical banded gastroplasty, gastric banding and Roux-en-Y gastric bypass.…”

A 3-year experience with laparoscopic gastric banding for obesity

“…In Switzerland, >20% of the adult population is overweight. Morbid obesity, defined by a body mass index (BMI) exceeding 40 kg/m 2 , is associated with numerous comorbid conditions and a significantly reduced life expectancy [1,2,6]. In these severe forms of obesity, conservative therapy almost inevitably fails to provide long-lasting weight reduction, and surgical treatment is usually recommended.…”

Bowel Habits after Gastric Bypass Versus the Duodenal Switch Operation

“…It is advocated by the National Institutes of Health for individuals with a body mass index (BMI) of 35-40 kg/m 2 and severe comorbidities or a BMI of >40 kg/m 2 [1]. Bariatric surgical procedures may be roughly categorized as restrictive, malabsorptive, and combined.…”