Obesity is a national health problem in the U.S. Thirty percent of the current American population is obese, compared with only 13 percent in 1960, placing a tremendous economic burden on the health-care system to care for the increased number of obesity-related health problems. An additional $30 billion is spent annually on medical weight-loss programs that use caloric restriction, exercise, or behavior modification and on appetite-suppressing medications. Though clouded in a history of less-than-successful attempts, surgery has finally emerged as the only effective long-term treatment for morbid obesity. Bariatric operations allow for substantial weight loss, extended weight maintenance, and control or reversal of obesity-related comorbidities. Several surgical options exist, each with their own pros and cons. Roux-en-Y gastric bypass is the gold standard. Lap-Band shows great promise. Biliopancreatic bypass is an effective operation for morbid obesity, however, long-term studies regarding nutritional and drug malabsorption are still lacking. The laparoscopic approach is now the access method of choice.
There is currently a very active effort to develop less-invasive methods of achieving weight loss. There are devices currently under investigation that provide some restriction without a formal surgical procedure. There is also significant work looking into gastric pacing/stimulation to help induce satiety and provide for weight loss. Scientists are actively measuring hundreds of hormones, cytokines, and metabolites before and during weight loss induced by surgery to try to see if there are any profiles that might predict success or failure for any given procedure. In the end, continued success of bariatric surgery will rest on the continuing refinement of the procedures themselves and also on the ability to select patients based on current knowledge, as well as novel biochemical predictors to increase the success of each procedure and to tailor the treatment to the patient. Regardless of the algorithm for selection or the procedure itself, the success of any surgical approach to morbid obesity requires a multidisciplinary team of internists, nurses, dietitians, psychologists, and surgeons to select the best candidates for this approach, to operate, and to provide long-term follow-up.
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