Surgical treatment of obesity

Abstract

More than half of the European population are overweight (body mass index (BMI) O25 and !30 kg/m 2 ) and up to 30% are obese (BMIR30 kg/m 2 ). Being overweight and obesity are becoming endemic, particularly because of increasing nourishment and a decrease in physical exercise. Insulin resistance, type 2 diabetes, dyslipidemia, hypertension, cholelithiasis, certain forms of cancer, steatosis hepatis, gastroesophageal reflux, obstructive sleep apnea, degenerative joint disease, gout, lower back pain, and polycystic ovary syndrome are all associated with overweight and obesity. The endemic extent of overweight and obesity with its associated comorbidities has led to the development of therapies aimed at weight loss. The long-term effects of diet, exercise, and medical therapy on weight are relatively poor. With respect to durable weight reduction, bariatric surgery is the most effective long-term treatment for obesity with the greatest chances for amelioration and even resolution of obesity-associated complications. Recent evidence shows that bariatric surgery for severe obesity is associated with decreased overall mortality. However, serious complications can occur and therefore a careful selection of patients is of utmost importance. Bariatric surgery should at least be considered for all patients with a BMI of more than 40 kg/m 2 and for those with a BMI of more than 35 kg/m 2 with concomitant obesity-related conditions after failure of conventional treatment. The importance of weight loss and results of conventional treatment will be discussed first. Currently used operative treatments for obesity and their effectiveness and complications are described. Proposed criteria for bariatric surgery are given. Also, some attention is devoted to more basic insights that bariatric surgery has provided. Finally we deal with unsolved questions and future directions for research. European Journal of Endocrinology 158 135-145

Ovarian function and obesity—Interrelationship, impact on women's reproductive lifespan and treatment options

“…Therefore, bariatric surgery should only be advocated to morbidly obese individuals after careful evaluation of the risk-tobenefit ratio. According to the current National Institute of Health clinical recommendations, surgical A c c e p t e d M a n u s c r i p t treatment of obesity should be considered when BMI is greater than 40 or greater than 35 in patients with a high-risk obesity-related condition following failure of other treatments for weight control (reviewed by Bult et al, 2008) . Results from an uncontrolled study assessing the effect of bariatric surgery in morbidly obese women with PCOS also reported sustained weight loss and complete resolution of all features defining PCOS, including hirsutism, hyperandrogenism, menstrual irregularity, anovulation, IR and metabolic abnormalities (Escobar-Morreale et al, 2005).…”

Gut microbiome-derived metabolites characterize a peculiar obese urinary metabotype

“…For this purpose, we analyzed the urine samples of obese patients by high-resolution proton NMR ( 1 H NMR) spectroscopy in combination with multivariate statistics. Furthermore, we investigated the obese metabolic phenotype (metabotype) changes in relation to two different bariatric surgery procedures (biliopancreatic diversion and Roux-en-Y gastric bypass) 9,10 that are detailed in the Supplementary Information.…”

Obesity and abdominal wound healing in rats

“…The aim of obesity treatment is weight loss, which leads to reduced insulin resistance, better control of diabetes mellitus, lower blood pressure, an improved lipid profile and, consequently, reduced risk of cardiovascular disease 2 . Studies have shown disappointing results for the conservative treatment of obesity in the long term, while there is evidence in the literature that surgical treatment of obesity can lead to more sustainable weight loss in selected patients 3 . Although there have been accurate indications and satisfactory results, there are considerable complications when obese or overweight patients are submitted to surgery, with incisional hernias being one of the most common delayed complications 4,8 .…”