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Obesity is the most common form of malnutrition in the
western world. It is a chronic disease with multiple and
complex causes, not just a problem of overeating. The control of
overweight is a lifetime enterprise. It is very important to
understand that medical interventions, including surgery, are
not the cure for obesity, but a way of controlling this disease.
More than one-third of the adult population is overweight or
obese. An estimated 19 million Americans are morbidly obese,
having increased risks for serious diseases and likelihood of
shorter life expectancy. This disease is called "morbid obesity"
because it is associated with progressive, serious and
debilitating diseases. It is a major contributor to diabetes,
high blood pressure, cardiovascular disease, stroke,
osteoarthritis of weight-bearing joints, respiratory problems,
gallstones, urinary incontinence, swollen legs that may develop
ulcers, and gastro-esophageal reflux. Also, the social,
psychological and economic consequences of morbid obesity are
devastating. Prejudice against the obese is common in American
society.
Bariatric Medicine and Surgery
This is the
branch of medicine, which deals with the treatment of
obesity. Surgery for morbid obesity is the only method that has
resulted in long-term maintenance of weight loss and reduction
in the associated diseases. Morbid obesity is usually defined as
being 100 lbs. over "ideal weight," as defined by the insurance
industry. Morbid obesity is treated by surgery because of the
serious risks related to this degree of obesity if left
untreated. Surgery has a relatively low risk of complications
and the alternatives of medical and dietary intervention are
essentially ineffective.
Results of Surgery
Weight loss following surgery for morbid obesity
varies. On average, 95% of patients lose about 30% or more of
their excess weight in 3 months, and 85% of patients have lost
at least 75% of their excess weight by 12 months. From this
point forward, 20% of all patients will gradually achieve an
ideal weight, usually by 18 months following surgery. The
average of all patients show a mild fluctuation of weight, with
a tendency to a slight weight regain of 2 to 5% of excess weight
from 18 months to four years of follow-up. Individuals who have
regained modest amounts of weight have the ability to reduce
their weight by returning to the more precise pattern of eating,
which was originally recommended.
Bariatric Surgery: Changing the Energy Balance
Operations for obesity are designed to change the
energy balance.
Energy balance is related to the amount of food
absorbed and the amount of energy used. Excess energy is stored
as fat.
Surgery may control obesity by changing energy
balance in two ways:
1. Decreasing
the intake of food (restriction), and
2. Causing
some of the food (i.e. sugars and fats) to be poorly digested
and incompletely absorbed (malabsorption) and, therefore,
eliminated in the stool.
Decreasing the intake of food is achieved through
the surgical approach. In general, operations for weight loss
attempt to create a small gastric pouch with a capacity of
about 20 cc (1 ½ oz.). The small pouch and the narrow outlet
produce early satiation (a feeling of fullness) that causes
behavioral changes leading to less caloric intake and,
therefore, weight loss.
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