Laparoscopic Adjustable Gastric Banding and Other Devices for the Management of Obesity

Obesity is a chronic relapsing disease associated with comorbidity, disability, psychosocial impairment, and reduced life expectancy. In most developed and developing countries, the prevalence of obesity and related diseases such as type 2 diabetes mellitus continues to rise. Today, about one third of US adults are obese, and although the prevalence has doubled over recent decades, the prevalence of the more severe forms of obesity has increased 5- to 10-fold. The determinants of the current epidemic are complex and very difficult to address at a population level. The World Health Organization recognizes obesity as a societal issue related to fundamental changes in behavior associated with industrialization, urbanization, and loss of traditional lifestyles. Genes and gene-environmental interaction are also critical. The explosion of interest in preconception, fetal, and early life nutrition has highlighted the potential importance of epigenetic and metabolic programming in setting the scene for an individual's weight trajectory. Certainly, a weight problem during adolescence heralds a very high risk of a lifelong battle with weight. Obesity may more broadly be seen as a marker for, but not a necessary element of, the chronic disease driven by fundamental industrial and postindustrial changes in the environment and human behavior. Obesity prevention will be challenging and will require a multidimensional environmental and societal makeover. Unfortunately, as physicians and healthcare providers, our role in primary prevention will be limited.