Surgical treatment of obesity

The growing epidemic of obesity, along with unsatisfactory results of most conventional weight reduction programs, has led to a remarkable rise in the number of bariatric surgical procedures worldwide (350,000 cases). The most common bariatric operations include gastric bypass, sleeve gastrectomy, gastric banding and biliopancreatic diversion, all of which are now performed laparoscopically with reduced invasiveness. In addition to achieving significant and durable weight loss (20-30%), bariatric surgery is associated with favorable metabolic effects and survival benefit far beyond those obtained by lifestyle modifications and pharmacological therapies. Recent randomized controlled trials demonstrate that bariatric surgery is superior to medical treatment of type 2 diabetes. Risks of bariatric surgery are similar to other gastrointestinal procedures and include a low mortality risk of 0.2% and major morbidity of < 5%. Bariatric surgery is best provided in multidisciplinary centers that include expertise in surgery, nutrition, psychology, endocrinology and internal medicine. Understanding mechanisms of surgically induced weight loss may provide insights into improved understanding of body weight regulation and lead to better nonsurgical weight loss treatment. Currently, bariatric surgery is the only weight loss therapy that can consistently result in clinically significant long-term weight loss for severely obese patients.