The role of gastric surgery in the multidisciplinary management of severe obesity

doi:10.1016/S0002-9610(99)80177-9

The American Journal of Surgery

Volume 169, Issue 3, March 1995, Pages 361-367

https://doi.org/10.1016/S0002-9610(99)80177-9 Get rights and content

Severe obesity affects the health and quality of life of 4 million Americans. The major cost of treating severe obesity and its associated comorbidities of hypertension, diabetes, cardiovascular disease, pulmonary insufficiency, cancer, and degenerative arthritis as well as the poor long-term results of medical, drug, and behavioral therapy has increased the numbers of patients being referred for surgical treatment. Gastric bypass and vertical banded gastroplasty are the two procedures recommended for severely obese patients. These operations currently have low morbidity and mortality. Surgery should be considered adjuvant therapy and must be part of a multidisciplinary approach. The significant long-term weight control resulting from the surgical therapy is associated with improvement and, often, resolution of comorbidities, including diabetes, hypertension, hyperlipidemia, and pulmonary insufficiency.

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Chronic diabetes leads to complex biochemical and cellular changes resulting in gastric dysfunction that is often underappreciated by care providers. While gastric symptoms of nausea, vomit, bloating, abdominal pain and early satiety are generally attributed to delay in gastric emptying, the latter poorly correlates with the timing or severity of these symptoms. Other physiological changes including rapid emptying, particularly of liquids, decreased accommodation, poor antropyloral coordination, gastric dysrhythmias, decreased or delayed onset of antral contractions, and hyperalgesia are generally not assessed clinically. A broader term of diabetic gastropathy appears more appropriate to represent the heterogeneous mixture of the various physiological disorders. Moreover, potentially underlying muscular, neuronal, hormonal and inflammatory changes in deeper submucosal structures may explain some of the complex aberrations in chronic diabetes, but remain poorly understood and has largely limited current therapies as empiric and palliative. Also newer understanding of driving forces in the progression of the metabolic syndrome has brought greater understanding for the role of hormonal and surgical therapies. Meanwhile, a better mechanistic understanding of gastric motility and of the various potential pharmacological agents, of which many are undergoing clinical studies as reviewed here, ushers hopes not only for more treatment options, but for optimal individualized therapy.
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Gestational weight gain and postpartum weight retention after bariatric surgery: data from a prospective cohort study
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It is unknown whether international guidelines on gestational weight gain can be used in pregnancies after bariatric surgery.
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In 127 patients with a mean age of 30.2 years (standard deviation [SD], 4.7), the mean gestational weight gain was 12.5 kg (SD, 6.7). Of these patients, 24% (30 of 127) showed insufficient weight gain, 20% (26 of 127) showed adequate weight gain, and 56% (71 of 127) showed excessive weight gain. Of 127 patients, 27 (21%) had small-for-gestational-age infants. This peaked in the group with insufficient weight gain (47%; 95% confidence interval [CI], 29%–65%; P < .001). The prevalence of large-for-gestational-age infants was comparable between groups, although highest in the group with excessive weight gain (0% in those with insufficient weight gain, 4% in those with adequate weight gain, and 8% in those with excessive weight gain). Preterm births were recorded more in patients with insufficient weight gain (23%; 95% CI, 8%–38%; P = .048). The mean amounts of postpartum weight retained were 4.0 kg (SD, 7.4) at 6 weeks and 3.0 kg (SD, 9.1) at 6 months. Weight retention at 6 weeks (7.1 kg; 95% CI, 5.5–8.7; P < .001) and 6 months (8.3 kg; 95% CI, 4.5–12.2; P < .001) was highest in women gaining excessive weight.
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Citation Excerpt :
Roux-en-Y gastric bypass has been widely applied in the clinical setting since it was first performed by Wittgrove and Clark in 1993.1 Laparoscopic Roux-en-Y gastric bypass surgery (LRYGB) is suggested as the effective management for morbid obesity, which can result in loss of 60%-70% of excess weight in obese patients.2,3 Type 2 diabetes mellitus (T2DM) is a serious complication of obesity.4
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ReviewThe role of gastric surgery in the multidisciplinary management of severe obesity

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Am J Cardiol

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Am J Clin Nutr

Am J Clin Nutr

Chest

Am J Clin Nutr

Am J Clin Nutr

Prevalence of severe obesity in adults in the United States

Am J Clin Nutr

Anthropometric reference data and prevalence of overweight, United States, 1976–1980

Prevalence of overweight and weight gain in the United States

Am J Clin Nutr

NIH Consensus Development Panel on the health implications of obesity

Ann Intern Med

National Institutes of Health Consensus Development Conference Statement. Gastrointestinal Surgery for Severe Obesity

Ann Intern Med

Pathophysiology of obesity

Am. J Clin Nutr

Definitions, measurements and classification of the syndrome's of obesity

Int J Obes

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J Clin Endocrinol Metab

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BMJ

Regional distribution of muscle and fat mass in men—new insight into the risk of abdominal obesity using computed tomography

Int J Obes

Abdominal adipose tissue distribution, obesity, and risk of cardiovascular disease and death: 13 year follow up of participants in the study of men born in 1913

BMJ

Health implications of overweight and obesity in the United States

Ann Intern Med

Overweight, hypertension, hypercholesterolemia and coronary heart disease

Obesity and hypertension

Ann Intern Med

Overweight and cancer

Ann Intern Med

Review
The role of gastric surgery in the multidisciplinary management of severe obesity