Surgical treatment of morbid obesity

WHO has listed obesity as a disease condition in its International Classification of Disease since 1979 and has assigned obesity a specific ICD-9, clinical modification code of #278.00, and morbid obesity, code #278.01. About 95% of those conservatively treated for morbid obesity will remain at the same weight or even gain weight during 5 years of follow-up. In 1991 an NIH Consensus Conference Panel convened and recommended that morbidly obese patients be offered an operative treatment for their disease. The weight loss mechanism of the bariatric operations is not clear, but the presumed effects are gastric restriction of food intake, malabsorption of the nutrients achieved by intestinal bypass, and secretion of different neuropeptides, that cause depression of the appetite and change in the metabolic rate. Restrictive operations are considered simpler and safer in terms of surgical performance and short term risks, but their efficacy is inferior to the malabsorptive ones. The latter are larger in regard to surgical extent, may cause more metabolic derangements, but produce more solid and long-lasting weight loss. The operation should be tailored to the candidate taking into consideration sex, age, health-related conditions, medications that are being taken, eating habits, and risks and benefits of every specific procedure. It is advisable that a bariatric surgery candidate undergo a thorough preoperative evaluation by a multidisciplinary team including a surgeon, a dietician, a psychology specialist, an internist or an endocrinologist, and other subspecialties as needed. A bariatric patient should maintain a life-long follow-up.