Surgical Treatment for the Overweight Patient

Abstract

Although considered the “cornerstones” of treatment of overweight, the magnitude of the weight loss that can be achieved with behavioral, dietary, exercise, and pharmacological approaches is limited to about 10% of initial body weight. Moreover, when the treatment is “stopped” because the patient is dissatisfied with the failure to lose enough weight or the cost is more than they want to pay, weight is regained over several months to a level that is close to baseline—treatments only work when used. If your body mass index was 30 kg/m2, a 10% weight loss would be to approximately 27 kg/m2, which is still above the normal level of 25 kg/m2. When overweight progresses to clinical overweight grade III, that is, a body mass index of higher than 40 kg/m2, many patients seek surgical treatment in which much more weight loss is the usual rule. The use of surgical procedures to treat overweight patients is increasing at a rapid rate (Fig. 1). Using the Nationwide Inpatient Sample from 1998 to 2002 provided a quantitative estimate of bariatric surgical procedures. Between 1998 and 2002 the number of operations increased from 13,365 to 72,177, a more than fivefold increase. More than 80% of these were the so-called gastric bypass operations. Several other trends were noted in this paper: An increase from 81 to 84% women being operated on; privately insured patients rising from 75 to 83% of these patients; and patients aged 50 to 64 rising from 15 to 24% of these people. Length of hospitalization decreased from 4.5 to 3.3 days, and operative mortality ranged from 0.1 to 0.2%. Thus, consideration of this growing form of treatment is important both for the patient and for the physicians and other health professionals who will care for these patients.