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Surgical treatment of obesity

Nature Clinical Practice Endocrinology & Metabolism volume 3, pages 574–583 (2007)Cite this article

Abstract

Obesity is very prevalent. Most treatments fail owing to hard-wired survival mechanisms, linking stress and appetite, which have become grossly maladaptive in the industrial era. Antiobesity (bariatric) surgery is a seemingly drastic, efficacious therapy for this serious disease of energy surfeit. Technical progress during the last two decades has greatly improved its safety. The surgical principles of gastric restriction and/or gastrointestinal diversion have remained largely unchanged over 40 years, although mechanisms of action have been elucidated concomitant with advances in knowledge of the molecular biology of energy balance and appetite regulation. Results of bariatric surgery in large case-series followed for at least 10 years consistently demonstrate amelioration of components of the insulin-resistance metabolic syndrome and other comorbidities, significantly improving quality of life. Furthermore, bariatric surgery has convincingly been demonstrated to reduce mortality compared with nonoperative methods. This surgery requires substantial preoperative and postoperative evaluation, teaching, and monitoring to optimize outcomes. In the absence of effective societal changes to restore a healthy energy balance, bariatric surgery is an important tool for treating a very serious disease.

Key Points

  • Bariatric surgery is safe; complications are fewer after restrictive procedures but weight loss and comorbidity reduction are greater after diversionary procedures

  • Most obesity comorbidity is durably (>10 years) ameliorated after surgery and mortality is less than after nonsurgical care

  • After bariatric surgery most patients do not reach 'normal' weight; however, the weight loss induced by surgery is sufficient to improve morbidity and mortality

  • A dedicated, comprehensive team is needed to assess, educate and manage the patient before and after surgery

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Figure 1: Different common techniques of bariatric surgery
Figure 2: Topography of putative appetitive signals affected by obesity operations, exemplified here by gastric bypass

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Acknowledgements

Désirée Lie, University of California, Irvine, CA, is the author of and is solely responsible for the content of the learning objectives, questions and answers of the Medscape-accredited continuing medical education activity associated with this article.

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Authors and Affiliations

  1. Department of Surgery, JG Kral is Professor of Surgery and Medicine, State University of New York Downstate Medical Center, Brooklyn, NY, USA;,

    John G Kral

  2. Department of Clinical Sciences, E Näslund is Professor of Surgery, Danderyd Hospital and Karolinska Institutet, Stockholm, Sweden.,

    Erik Näslund

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Correspondence to John G Kral.

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Kral, J., Näslund, E. Surgical treatment of obesity. Nat Rev Endocrinol 3, 574–583 (2007). https://doi.org/10.1038/ncpendmet0563

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