Surgical management of obesity

Severe obesity is not treatable by any of the current weight-loss approaches: diet, exercise, pharmacotherapy, or behavioral therapy. Gastric surgery has been shown to be the only effective way to reduce the significant morbidity and mortality associated with excess weight (≥100 lb over ideal body weight). Surgery is a permanent solution requiring lifelong follow-up. Each type of gastric surgery causes malabsorption, mechanical restriction of food intake, or both, resulting in weight loss. For efficacy and safety, gastric bypass surgery - traditionally performed as an open incision - is the gold standard. Laparoscopic versions of this surgery are now being performed and lead to weight loss comparable to that achieved with open-incision surgery. Laparoscopic adjustable banding is also showing promise, particularly in less severe cases of obesity. However, the results from long-term follow-up data on laparoscopic gastric bypass and adjustable banding are not yet available. This article provides the primary care physician with an overview of gastric surgery for obesity, as well as the recommended criteria for selecting candidates for this procedure.