Management: Part III—Surgery

professor of surgery and medicine in the department of surgery, SUNY Downstate Medical Center, New York. Although surgery can be a potentially life extending treatment for obesity, most patients and doctors reject surgical intervention. Moreover, no national health budget or insurance can afford surgery on a very large scale. However, obesity surgery is a successful, validated, legitimate treatment and needs to be considered in some circumstances. Healthcare workers and the public alike still lack awareness about the epidemiological consequences of and the severity of outcomes associated with pregnancy in obese women. Outcomes include fetal loss, malformations, intellectual impairment, lifelong psychosocial suffering, and programming of chronic metabolic diseases. People also lack awareness about the epigenetic transmission of obesity to their daughters, who themselves go on to become obese mothers. View this table: Goal and methods of obesity surgery Given the seriousness of the obesity epidemic, “preventive surgery” in obese young women may therefore be indicated when all else fails. Furthermore, such surgery can prevent the inexorable progression of obesity towards manifest comorbidity (such as diabetes, congestive heart failure, liver cirrhosis, and hypertension) and, ultimately, irreversible chronic disease and end organ failure. View this table: Key prerequisites for obesity surgery Obesity surgery entails a trade-off between the progressively debilitating intractable symptoms and chronic diseases associated with obesity and the side effects and complications of operations designed to create chronic (relative) undernutrition. Most obese adults who have chosen surgery and had complications (including death) have been satisfied with their choice because their lives as obese individuals were often not worth living. Early obesity surgery can bring secondary health problems. Nevertheless, the extraordinary lifelong suffering imposed by the psychosocial sequelae of extreme childhood obesity cannot be underestimated: depression, anxiety, eating disorders, vocational and marital failure, and years of life lost. Mitigating the impairment of quality of life might well be …