Surgery for Severe Obesity

Authored by: Robert F. Kushner , Lisa M. Neff

Lifestyle Medicine

Print publication date:  March  2013
Online publication date:  March  2013

Print ISBN: 9781439845424
eBook ISBN: 9781315099248
Adobe ISBN:


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Various expert panels have endorsed bariatric surgery as an acceptable weight-loss option for patients with a BMI of ≥40 kg/m2 or those with a BMI of ≥35 kg/m2 who have comorbid conditions [17]. An international survey of 36 nations or national groups estimated that over 344,000 bariatric surgery operations were performed in 2008; 220,000 of these operations were performed in the United States or Canada [8]. The exponential growth in procedures is due to several factors including improved surgical techniques, reduction in the postoperative mortality rate, significant improvement in obesity-related comorbid conditions [9], increased media attention, and profitability. The upsurge in surgical procedures also reflects the increasing prevalence of severe obesity in the United States. Between 1986 and 2000, the prevalence of severe obesity (BMI ≥ 40 kg/m2) quadrupled from about 1 in 200 adult Americans to 1 in 50; the prevalence of a BMI of ≥ 50 increased by a factor of 5, from about 1 in 2000 to 1 in 400 [10]. Nearly 6% of adult Americans are considered severely obese with prevalence figures reaching 14% for African-American women [11]. It is therefore likely that health care professionals from all disciplines will encounter patients who have undergone a bariatric surgical procedure. Similarly, primary care physicians will be expected to monitor and manage their patients on a long-term basis. Many of the weight-loss surgeries, most notably the combined restrictive–malabsorptive surgical procedure—Roux-en-Y gastric bypass (RYGB)—and the malabsorptive biliopancreatic diversion (BPD) and biliopancreatic diversion with duodenal switch (BPDDS), place patients at high risk for development of both macro- and micronutrient deficiencies unless they are properly counseled and supplemented. Since most of the deficiencies can be identified early at a preclinical stage, early treatment will prevent or reduce symptoms and deficiency syndromes. Although bariatric surgery does not cure obesity, it is considered a significant tool for weight loss and maintenance of weight loss. As such, patients are at risk to experience weight regain several years following surgery. This chapter will review the most commonly performed weight-loss procedures, the importance of preoperative and postoperative management, identification and management of nutritional deficiencies that may occur following bariatric surgery, and factors associated with weight regain.

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