Surgery for Obesity

AS BARIATRIC SURGERY FOR THE treatment of patients with morbid obesity surges in popularity in the United States, ethical and scientific questions about the approach are mounting. While bariatric surgery has been performed since the 1960s, improvements in laproscopic methods and a 1991 Consensus Statement by the National Institutes of Health (NIH) that established criteria for eligibility for surgical treatment of morbid obesity opened the door for insurance coverage and set the stage for an explosive increase in its use. According to the American Society for Bariatric Surgery (ASBS), about 47000 surgeries for treatment of morbid obesity were performed in 2001. Last year about 63000 bariatric surgeries were performed and this year an estimated 98000 will be done. The majority of procedures are: Roux-en-Y gastric bypass, stapled gastroplasty, and adjustable gastric banding—all of which are designed to reduce stomach size and thus control calorie intake ( JAMA. 2002;288:2793-2796). The NIH criteria for obesity surgery eligibility are a well informed and motivated patient with a body mass index (BMI) of greater than 40, or a patient with less severe obesity (BMI greater than 35) who has high-risk, comorbid conditions such as type 2 diabetes and cardiopulmonary problems.