Bariatric surgery to treat obesity.

Obesity has become a global health problem that contributes to numerous life-threatening and disabling diseases, such as type 2 diabetes mellitus and coronary artery disease. The long-term results of traditional weight loss therapies, including diet, exercise, and medications, are relatively poor. Bariatric surgery is the most effective treatment of morbidly obese patients to allow substantial, sustained weight loss and to improve or resolve obesity-associated comorbidities, thereby reducing mortality. According to US practice guidelines, patients qualify for bariatric surgery with a body mass index of 35 kg/m(2) and associated comorbidities, or a body mass index of 40 kg/m(2), after failure of conservative weight loss measures. Currently, the established procedures in the United States are the laparoscopic Roux-en-Y gastric bypass, adjustable gastric banding, sleeve gastrectomy, and biliopancreatic diversion with duodenal switch. The surgeries vary substantially in their postoperative amount of weight loss, resolution of comorbidities, nutritional requirements, and nature and severity of complications. There is no perfect bariatric surgery, an informed risk and benefit assessment should be made by each patient. The procedures are safe, with a mortality rate of 0.3%. Sustained weight loss depends finally on patient re-education in terms of diet, need for regular exercise, and careful bariatric follow-up evaluation.