|Description||Context: Over 23 million Americans are afflicted with severe obesity, i.e. their body mass index (in
kilograms per square meter) values exceed 35. Of even greater concern is the association of the
adiposity with comorbidities such as diabetes, hypertension, cardiopulmonary failure, asthma,
pseudotumor cerebri, infertility, and crippling arthritis.
Objective: Diets, exercise, behavioral modification, and drugs are not effective in these individuals.
This article examines the effect of surgery on the control of the weight and the comorbidities, as
well as the safety of these operations.
Interventions: Although the article focuses on the outcomes of the three most commonly performed
operations, i.e. adjustable gastric banding, the gastric bypass, and the biliopancreatic
bypass with duodenal switch, it aims for perspective with the inclusion of abandoned and current
investigational procedures, a review of the complications, and an emphasis on the appropriate
selection of patients.
Positions: Ample evidence, including controlled randomized studies, now document that bariatric
surgery produces durable weight loss exceeding 100 lb (46 kg), full and long-term remission of type
2 diabetes in over 80% with salutary effects on the other comorbidities as well with significant
reductions in all-cause mortality. Although the severely obese present with serious surgical risks,
bariatric surgery is performed safely with a 0.35% 90-d mortality in Centers of Excellence throughout
the United Statesâ similar to the complication rates after cholecystectomy.
Conclusions: Until better approaches become available, bariatric surgery is the therapy of choice
for patients with severe obesity. Originally published J Clin Endocrinol Metab 93: S89â S96, 2008||en_US