Clinical Review

Surgery for obesity in adulthood

BMJ 2009; 339 doi: https://doi.org/10.1136/bmj.b3402 (Published 22 September 2009) Cite this as: BMJ 2009;339:b3402
  1. Daniel Richard Leff, academic clinical lecturer in general surgery 1,
  2. Dugal Heath, consultant laparoscopic and bariatric surgeon and honorary senior lecturer2
  1. 1Department of BioSurgery and Surgical Technology, St Mary’s Hospital, London W2 1NY
  2. 2North London Obesity Surgery Service (NLOSS), Department of Surgery, Whittington Hospital NHS Trust, London N19 5NF
  1. Correspondence to: D Heath Dugal.Heath{at}whittington.nhs.uk
  • Accepted 1 August 2009

Summary points

  • Morbid obesity is associated with comorbidities and reduced life expectancy

  • Bariatric surgery is the only treatment for morbid obesity that has been shown to produce long term weight loss

  • Common procedures used for weight loss include gastric banding, Roux-en-Y gastric bypass, and sleeve gastrectomy

  • Bariatric surgery has been shown to lead to sustained weight loss, resolution of comorbidities, and improved life expectancy

The relation between morbid obesity, serious morbidity, and early mortality is well known (fig 1 and table 1).1 2 A recent systematic review of over 890 000 participants found that each 5 point increase in body mass index (kg/m2) over 25 was associated with a 30% increase in overall mortality.3 Conservative approaches to managing obesity (dieting, exercise, and cognitive behavioural therapy) achieve long term weight loss in only a small minority of highly motivated individuals.4 Weight loss drugs such as orlistat and sibutramine produce modest weight loss and can be prescribed only for a short time.5 Bariatric (weight loss) surgery is the only treatment that randomised controlled trials have shown to produce effective long term weight loss.6 This review provides an overview of surgical procedures for adult obesity, including results, follow-up, and complications of surgery. It focuses mainly on practice in the United Kingdom.

Fig 1 Proportion of people with a major comorbidity, by degree of obesity. Adapted from Mokdad et al2

View this table:
Table 1

 Risk of developing diseases associated with obesity. Data adapted from guidance from the National Institute for Health and Clinical Excellence1

Who should be considered for weight loss surgery?

Categories of obesity are classified according to body mass index (weight(kg)/(height (m)2)) (table 2). Recommendations on the management of obesity in adults are provided in guidelines published by the National Institute for Health and Clinical Excellence (NICE).1

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Table 2

Classification of obesity based on body …

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