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ESSENTIAL CONCEPTS

ESSENTIAL CONCEPTS

  • Body mass index (BMI) >25 is considered overweight; >30, grade I obesity; >35, grade II obesity; >40, grade III obesity; and >50, “super obesity.”

  • Using these criteria, two-thirds of Americans are overweight or obese.

  • Diet, pharmacotherapy, and behavior modification are the available nonsurgical treatment options and are of limited efficacy, with durable weight loss rarely exceeding 10 kg.

  • Patients with a BMI >35 can be considered for bariatric surgery if they have severe weight-related comorbid conditions (eg, diabetes, hypertension, disabling arthritis, or sleep apnea).

  • Patients with a BMI >40 may be appropriate surgical candidates, with or without weight-related comorbid conditions.

  • Two long-term studies of the efficacy of bariatric surgery noted a 29–40% reduction in all causes of death, with decreased mortality from coronary artery disease, stroke, diabetes, and cancer.

  • Several studies have documented the profound effects that bariatric surgical procedures have in the treatment of diabetes. The American Diabetes Association and the International Federation for Diabetes now recommend that bariatric surgery be considered for morbidly obese individuals who have poorly controlled type 2 diabetes with medical therapy.

General Considerations

Obesity has reached epidemic proportions worldwide and continues to exact a high cost in human and monetary terms within the United States. This disease is second only to cigarette smoking as a preventable cause of death and deaths attributable to obesity far outnumber colon cancer. Three hundred thousand people die annually from obesity-related disorders in the United States. In addition, health care costs to treat obesity and weight-related conditions exceed $100 billion annually. This problem is of particular concern because upwards of one-third of adult Americans are obese, with 15% of the population potentially meeting the criteria for bariatric surgery. In short, obesity is a major public health problem that requires aggressive prevention and treatment.

Weight loss surgery has been recognized for decades as an effective treatment of obese individuals. Although the number of bariatric procedures has leveled off over the past few years it is estimated that 340,000 bariatric procedures are still performed annually worldwide. Surgical treatment of obesity is routinely associated with loss of greater than 100 lb. Hence, it is not surprising that patients who undergo such operations can have substantial amelioration of co-morbid conditions.

Bariatric surgery may not be the ideal obesity treatment. However, surgery is currently the most effective and durable treatment of the obese compared with any other available therapy in terms of weight loss, alleviation of comorbid conditions, reduction in mortality risk, and decreased long-term health care costs.

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Maggard  MA, ...

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