Surgery for Obesity:
Procedures and Weight Loss
WALTER J. PORIES
JOSEPH E. BESHAY
Obesity becomes a serious disease when it is morbid, that is, when the body mass index (BMI) exceeds 40 kg/m2, equivalent to 100 pounds of excess weight. The 5 million Americans who are so afflicted are not only limited by their bulk but also have a high prevalence of diabetes, hypertension, coronary and peripheral vascular disease, congestive heart failure, obstructive sleep apnea, mechanical arthropathy, endocrine disorders, infertility, and cancers of the endometrium, prostate, and breast (see Chapters 76 and 84). In addition, the morbidly obese often suffer disabling psychological and socioeconomic consequences as a result of their excess weight (see Chapters 20 and 71). Although diet, exercise, behavioral therapies, and some recent medications are effective for many obese individuals, the results are disappointing in the morbidly obese.
Today, surgery remains the only proven effective therapy for long-term control of morbid obesity (see Chapter 102). Candidates include individuals with a BMI > 40 or those with a BMI > 35 who also present with any of comorbidities of obesity as outlined earlier. Contraindications to surgery include unacceptably high operative risk, unresolved substance abuse, high likelihood of noncompliance with postoperative followup, significant uncontrolled emotional disease such as depression or history of suicidal attempts, failure to understand the procedure, or unrealistic expectations from the operation.