Surgical treatmentof extreme obesity

The Surgeon General has identified obesity as a leading threat to public health in the United States. It is associated with a wide variety of chronic diseases, which are exacerbated by increasing degrees of overweight. Starting points for treatment of obesity include diet, exercise, and behavioral therapy. Medication can be added to help effect weight loss. However, there is a growing consensus that weight reducing (bariatric) surgery is the treatment of choice for extremely obese individuals who have failed to reduce their weight through dietary, behavioral, and pharmacologic interventions. The two operations that have been most widely used in the United States are vertical banding gastroplasty and Roux-en-Y gastric bypass. Between these, gastric bypass appears to have better long-term effectiveness in reducing weight and managing comorbidities related to obesity. More important than enabling the patient to reach an ideal body weight, bariatric surgery can be very effective in ameliorating, or even resolving, obesity-related diseases.