Obesity is the world's oldest metabolic disorder. There has been evidence of
obesity in societies since the Stone Age. 40 million adult Americans weigh more
than 20 % above their desirable weight. Through the years, obesity has been increasing
within all races and sexes from the age 25 through 44. It has been determined that
the development of obesity is a complex relationship of factors involving genetics,
culture, socioeconomics and psychological issues.
Obesity remains a major health problem in the world today. Total mortality related
to obesity is predominately a result from comorbidities (such as coronary artery
disease, diabetes, hypertension etc.) An obese patient has a 3.8% greater risk of
Type II diabetes and a 5.6% greater risk of hypertension. This patient also
has a 2.1% greater risk of hypercholesterolemia (high cholesterol). Research has
also found obesity is associated with other diseases such as degenerative joint
disease (knees, hips, ankles), pulmonary emboli, heart failure, thromboembolic
disorders, sleep apnea, gallstones, urinary stress incontinence and reflux-esophagitis.
There is also an increase in the risk of certain cancers including colon rectal,
prostate, uterine, ovarian and breast.
In the past, morbid obesity has been measured by standards based on Life insurance
tables. A newer, more accurate measure for obesity is the Body Mass Index (BMI).
The BMI is calculated by dividing the weight in kilograms by height measured in meters,
squared (W/H2). Patients with a BMI of 22 -25 kg/m2 seemingly have the lowest morbidity
and mortality rate. Morbidity and mortality rates begin to increase when an individual's
weight is greater than 20% of their ideal weight. The National Institute of Health
Consensus has defined obesity as a BMI that is greater than 30 kg/m2., and morbid obesity
as a BMI greater than 40 kg/m2 (approximately 100 lbs. over ideal weight).
Morbid obesity and the related complications have to be reversed. However, conservative
treatments of obesity have shown results concluding that less than 5% of patients can
lose and maintain a 40 lb. weight loss after one year of treatment. Surgery is found
to be the only successful long term treatment for morbid obesity for patients with a BMI greater than 40 kg/m2.
A new issue recently becoming very important in the field of obesity is
» adolescent obesity
» bariatric surgery for older group of patients greater than 60 years old
Another aspect is the laparoscopic approach to bariatric surgery.
Why do I not perform laparoscopic duodenal switch procedure at this point?
I believe that the duodenal switch procedure performed laparoscopicly cannot be
as percise as an open procedure. The percentage of complications is greater and
results are not as successful. However, the rate of an incisional hernia following
the laparoscopic approach is lower if procedure is performed totally laparoscopicly.
