Editorials

Obesity surgery—another unmet need

BMJ 2000; 321 doi: http://dx.doi.org/10.1136/bmj.321.7260.523 (Published 02 September 2000) Cite this as: BMJ 2000;321:523

It is effective but prejudice is preventing its use

  1. John Baxter, professor of general surgery
  1. Postgraduate Medical School, University of Wales, Swansea SA2 8PP

    Obesity, defined as having a body mass index >30 kg/m2, is dramatically increasing in incidence in the Western world. For example, 20 years ago 5% of the population in the United Kingdom was obese; now 17% is.1 The annual healthcare costs arising directly from obesity are at least £2bn ($3bn) in the United Kingdom and £45bn ($68bn) in the United States. 2 3 Data from several sources have identified the increased morbidity and mortality associated with obesity.4 Most patients who are obese are treated with a combination of advice on diet and lifestyle and in some cases with drugs. However, for patients who have morbid obesity (body mass index >40), this conservative approach is doomed to failure.

    If left untreated patients who are morbidly obese (1-2% of the population in the United Kingdom) have only a 1 in 7 chance of reaching their normal life expectancy. A Cochrane review in 1997 noted that good results had been obtained from surgery for obesity in these patients.5 Over the past decade both the National Institutes of Health in the United States and the Scottish Intercollegiate Guidelines Network have suggested that surgery is the most effective treatment for selected patients who are morbidly obese; both organisations have …

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