Obesity is an important health care problem in the USA. One in three individuals are >20% over ideal body weight and approximately 5% have serious weight-related health problems. Clinically severe or medically complicated obesity refers to individuals who are 100% or more over ideal body weight. The estimated prevalence of "morbid obesity" in the USA is 2% for men and 6% for women. Severe obesity with a body mass index (BMI) > 40 is associated with a 6 to 12 fold increase in overall mortality when compared with non-obese individuals.
Modifications in diet, behavior, exercise, and medical weight loss regimens should represent the initial approach to weight management. Unfortunately, the long-term results of these strategies have been disappointing to date. Although many patients will temporarily lose weight, only 5-10% will successfully maintain weight loss for more than a few years. Consequently, patients with significant medical problems related to severe obesity may benefit from surgery to facilitate weight loss.
The most appropriate therapy for an obese individual must be based on the relative risk/benefit ratio of medical verses surgical therapy. Surgical treatment of obesity (bariatric surgery) may be considered when the risk of obesity related medical problems exceeds the risk of complications related to surgical intervention. Severe obesity is associated with an increased risk of numerous medical problems including:
- Coronary Artery Disease
- Degenerative Joint Disease
- Fatty Liver or Hepatosteatonecrosis
- Gastroesophageal Reflux
- Hyperlipidemia or hypercholesterolemia
- Pulmonary Hypertension
- Sleep Apnea
- Venous stasis of the lower extremities
The goal of bariatric surgery is to induce and maintain weight loss of >50% of excess body weight. The weight loss is most rapid for the first 6 months, then slowly plateaus approximately 18 to 24 months following surgery. Most patients experience significant improvement or resolution of weight-related medical problems following bariatric surgery.