Surgical Approaches to the Treatment of Obesity

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Abstract
This is a review of indications for surgery of obesity, principles and methods, results and limitations, and mechanisms of weight loss. Hazards of obesity appear at a weight greater than 20% above ideal weight for height, and increase exponentially with increasing weight. Morbid obesity, at levels 45 kg. above ideal, is best treated by surgical means, though success over the long term is only around 50–60%. Gastric restriction, malabsorption, and regulatory methods, and combinations thereof will usually achieve an overall mean weight loss of ⅓ of preoperative body weight. Interpretation of data is encumbered by varying and fairly high drop-out rates and inconsistencies in reporting. The most common mechanism explaining weight loss seems to be aversiveness, though some procedures are claimed to cause satiety. The most important objective of future work in the field of obesity surgery is the development of predictors of response to surgery to improve patient selection.

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