Surgical treatment of obesity

Obesity has been described by the World Health Organization as a global epidemic. The number of people worldwide with a body mass index (BMI) in the obese range (>30) is estimated to be 1.7 billion.1 In the United Kingdom in 2002 70% of men and 63% of women were reported as being overweight (BMI>25), with one in five classed as obese. If current trends continue, conservative estimates are that at least a third of adults will be obese by 2020.2

Obesity is big cause of preventable morbidity and premature mortality (see box for associated conditions).3 A number of mechanisms are involved in the pathophysiology of its complications. Insulin resistance probably plays a central role. Changes in proinflammatory cytokines and hormones released from the gut and adipose tissue have also been implicated.4 Even modest weight loss (10 kg) has a pronounced impact on long term health. This weight loss is, however, difficult to achieve and sustain with conventional measures.

The apparent failure of conventional treatments has led to growing interest in bariatric surgery. Stories about weight loss surgery are now common in the popular press. From glowing reports of transformed lives to horror stories of surgeries gone wrong, this surgery has gained notoriety recently, particularly with celebrities such as Anne Diamond and Sharon Osborne undergoing these procedures. It is not surprising, therefore, that the facts get distorted along the way.

In this article, we outline the procedures commonly used in the surgical treatment of obesity; the effectiveness and safety of these procedures; and current guidelines on which patients are appropriate for these measures.