Bariatric Surgery: Crossing a Body Mass Index Threshold
Authors: Thomas A. Wadden, Adam Gilden Tsai
Journal: Annals of Internal Medicine (2006)

Editorials2 May 2006Bariatric Surgery: Crossing a Body Mass Index ThresholdThomas A. Wadden, PhD and Adam Gilden Tsai, MD, MSThomas A. Wadden, PhDFrom the University of Pennsylvania School of Medicine, Philadelphia, PA 19104.Search for more papers by this author and Adam Gilden Tsai, MD, MSFrom the University of Pennsylvania School of Medicine, Philadelphia, PA 19104.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-144-9-200605020-00013 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail As many as 5% of adults in developed nations now have extreme obesity, characterized by a body mass index (BMI) of 40 kg/m2 or more (1). These individuals have a mortality rate that is at least double that of individuals with a BMI in the desirable range of 18.5 kg/m2 to 24.9 kg/m2(2). More than 40 years of research has shown that surgical intervention, particularly the gastric bypass, is the treatment of choice for extremely obese individuals who cannot control their weight with traditional methods, such as lifestyle modification or pharmacotherapy (3, 4). Bariatric surgery also is indicated for individuals ...References1. Hedley AA, Ogden CL, Johnson CL, Carroll MD, Curtin LR, Flegal KM. Prevalence of overweight and obesity among US children, adolescents, and adults, 1999-2002. JAMA. 2004;291:2847-50. [PMID: 15199035] CrossrefMedlineGoogle Scholar2. Flegal KM, Graubard BI, Williamson DF, Gail MH. Excess deaths associated with underweight, overweight, and obesity. JAMA. 2005;293:1861-7. [PMID: 15840860] CrossrefMedlineGoogle Scholar3. Maggard MA, Shugarman LR, Suttorp M, Maglione M, Sugerman HJ, Livingston EH, et al. Meta-analysis: surgical treatment of obesity. Ann Intern Med. 2005;142:547-59. [PMID: 15809466] LinkGoogle Scholar4. Buchwald H, Avidor Y, Braunwald E, Jensen MD, Pories W, Fahrbach K, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004;292:1724-37. [PMID: 15479938] CrossrefMedlineGoogle Scholar5. Obesity: Preventing and Managing the Global Epidemic: Report of a WHO Consultation on Obesity. Geneva: World Health Organization; 1998. Google Scholar6. Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults—The Evidence Report. National Institutes of Health. Obes Res. 1998; 6 Suppl 2 51S-209S. [PMID: 9813653] MedlineGoogle Scholar7. O'Brien PE, Dixon JB, Laurie C, Skinner S, Proietto J, McNeil J, et al. Treatment of mild to moderate obesity with laparoscopic adjustable gastric banding or an intensive medical program. A randomized trial. Ann Intern Med. 2006;144:625-33. LinkGoogle Scholar8. Wadden TA, Butryn ML, Byrne KJ. Efficacy of lifestyle modification for long-term weight control. Obes Res. 2004; 12 Suppl 151S-62S. [PMID: 15687411] CrossrefMedlineGoogle Scholar9. Anderson JW, Brinkman-Kaplan VL, Lee H, Wood CL. Relationship of weight loss to cardiovascular risk factors in morbidly obese individuals. J Am Coll Nutr. 1994;13:256-61. [PMID: 8077574] CrossrefMedlineGoogle Scholar10. Sjöström L, Rissanen A, Andersen T, Boldrin M, Golay A, Koppeschaar HP, et al. Randomised placebo-controlled trial of orlistat for weight loss and prevention of weight regain in obese patients. European Multicentre Orlistat Study Group. Lancet. 1998;352:167-72. [PMID: 9683204] CrossrefMedlineGoogle Scholar11. Davidson MH, Hauptman J, DiGirolamo M, Foreyt JP, Halsted CH, Heber D, et al. Weight control and risk factor reduction in obese subjects treated for 2 years with orlistat: a randomized, controlled trial. JAMA. 1999;281:235-42. [PMID: 9918478] CrossrefMedlineGoogle Scholar12. James WP, Astrup A, Finer N, Hilsted J, Kopelman P, Rössner S, et al. Effect of sibutramine on weight maintenance after weight loss: a randomised trial. STORM Study Group. Sibutramine Trial of Obesity Reduction and Maintenance. Lancet. 2000;356:2119-25. [PMID: 11191537] CrossrefMedlineGoogle Scholar13. Whelton PK, Appel LJ, Espeland MA, Applegate WB, Ettinger WH, Kostis JB, et al. Sodium reduction and weight loss in the treatment of hypertension in older persons: a randomized, controlled trial of nonpharmacologic interventions in the elderly (TONE). TONE Collaborative Research Group. JAMA. 1998;279:839-46. [PMID: 9515998] CrossrefMedlineGoogle Scholar14. Knowler WC, Barrett-Connor E, Fowler SE, Hamman RF, Lachin JM, Walker EA, et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002;346:393-403. [PMID: 11832527] CrossrefMedlineGoogle Scholar15. Santry HP, Gillen DL, Lauderdale DS. Trends in bariatric surgical procedures. JAMA. 2005;294:1909-17. [PMID: 16234497] CrossrefMedlineGoogle Scholar16. Sjöström L, Lindroos AK, Peltonen M, Torgerson J, Bouchard C, Carlsson B, et al. Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. N Engl J Med. 2004;351:2683-93. [PMID: 15616203] CrossrefMedlineGoogle Scholar17. Wadden TA, Sarwer DB, Womble LG, Foster GD, McGuckin BG, Schimmel A. Psychosocial aspects of obesity and obesity surgery. Surg Clin North Am. 2001;81:1001-24. [PMID: 11589242] CrossrefMedlineGoogle Scholar18. Flum DR, Dellinger EP. Impact of gastric bypass operation on survival: a population-based analysis. J Am Coll Surg. 2004;199:543-51. [PMID: 15454136] CrossrefMedlineGoogle Scholar19. Agren G, Narbro K, Jonsson E, Näslund I, Sjöström L, Peltonen M. Cost of in-patient care over 7 years among surgically and conventionally treated obese patients. Obes Res. 2002;10:1276-83. [PMID: 12490672] CrossrefMedlineGoogle Scholar20. Brownell KD, Horgen KB. Food Fight: The Inside Story of the Food Industry, America's Obesity Crisis, and What We Can Do About It. New York: McGraw-Hill; 2004. Google Scholar Author, Article, and Disclosure InformationAffiliations: From the University of Pennsylvania School of Medicine, Philadelphia, PA 19104.Grant Support: In part by a National Institutes of Health Midcareer Investigator Award in Patient-Oriented Research (K24-DK65018) (T.A. Wadden).Disclosures: Consultancies: T.A. Wadden (Abbott Laboratories); Honoraria: T.A. Wadden (Abbott Laboratories, Roche [not active]); Grants received: T.A. Wadden (Abbott Laboratories).Corresponding Author: Thomas A. Wadden, PhD, University of Pennsylvania, 3535 Market Street, Suite 3029, Philadelphia, PA 19104; e-mail, [email protected]med.upenn.edu.Current Author Addresses: Dr. Wadden: University of Pennsylvania, 3535 Market Street, Suite 3029, Philadelphia, PA 19104.Dr. Tsai: University of Pennsylvania, 3535 Market Street, Suite 3024, Philadelphia, PA 19104. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoTreatment of Mild to Moderate Obesity with Laparoscopic Adjustable Gastric Banding or an Intensive Medical Program Paul E. O'Brien , John B. Dixon , Cheryl Laurie , Stewart Skinner , Joe Proietto , John McNeil , Boyd Strauss , Sharon Marks , Linda Schachter , Leon Chapman , and Margaret Anderson Metrics Cited ByWeight Loss Surgery for Mild to Moderate Obesity: A Systematic Review and Economic EvaluationPerioperative Outcomes of Laparoscopic Adjustable Gastric Banding in Mildly Obese (BMI < 35 kg/m2) Compared to Severely ObeseAdiposopathy and bariatric surgery: is ‘sick fat’ a surgical disease?Methods of Weight ControlSleep and Quality of Life in Obesity 2 May 2006Volume 144, Issue 9Page: 689-691KeywordsBariatric surgeryBody mass indexDrug therapyHealth care providersObesityOverweightSurgeryType 2 diabetesWeight loss ePublished: 2 May 2006 Issue Published: 2 May 2006 CopyrightCopyright © 2006 by American College of Physicians. All Rights Reserved.PDF DownloadLoading ...