Modern management of obesity

Abstract

Fig 1(c). Bilio-pancreatic diversion with duodenal switch (BPD-DS):this is more complicated and a technically challenging procedure which causes weight loss mainly by malabsorption. A sleeve gastrectomy is performed (rather than the horizontal gastrectomy performed in the Scopinaro type) leaving a gastric reservoir of 150-200 ml. The duodenum is closed about 2 cm distal to the pylorus and a duodeno-ileal anastomosis is performed. The common limb is about 75-100 cm where food from the alimentary limb mixes with the biliary and pancreatic juices causing significant malabsorption. This procedure can be done in two stages in very obese subjects or patients with high mortality risk. The weight loss results are impressive with significant improvements in co-morbidities but this procedure carries a high mortality and complication risk. Protein malnutrition and nutritional deficiencies are a concern, particularly in patients who are unable to follow strict dietary changes that are required.

Genetics and Intervention Research

“…More fundamentally, knowing what is has no necessary implications for what could be . A highly heritable disorder can be changed dramatically by a novel environmental intervention, as in the extreme example of severe obesity and gastric bands (Aditya & Wilding, 2009). …”