When is bariatric surgery indicated?

Updated: May 28, 2019
  • Author: Alan A Saber, MD, MS, FACS, FASMBS; Chief Editor: John Geibel, MD, MSc, DSc, AGAF  more...
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Answer

Obesity is a major health problem worldwide and has reached an epidemic proportion in the Western society. Evidence continues to accumulate that obesity is a major risk factor for many diseases and is associated with significant morbidity and mortality.

The most widely accepted measure of obesity is the body mass index (BMI). This number is calculated by dividing a patient's mass (kg) by his or her height (m2). A normal BMI is considered in the range of 18.5-24.9 kg/m2. A BMI of 25-29.9 kg/m2 is considered overweight. A BMI of 30 kg/m2 or greater is classified as obese; this classification is further subdivided into class I, II, or III obesity.

Considering other factors (eg, total muscle mass, waist circumference) besides the BMI may be important. For example, an extremely muscular individual may have an elevated BMI without being considered overweight. Waist circumference has been shown to be an excellent indicator of abdominal fat mass. A circumference of greater than 88 cm (35 in.) in women or greater than 102 cm (40 in.) in men strongly correlates with an increased risk of obesity-related disease.

Bariatric surgery is currently the only modality that provides a significant, sustained weight loss for morbidly obese patients, with resultant improvement in obesity-related comorbidities. A prospective, controlled Swedish study involving 4047 obese patients, half of whom had undergone bariatric procedures, followed up over 14.7 years, found that compared to usual care, bariatric surgery was associated with a significantly reduced number of cardiovascular deaths and a lower incidence of cardiovascular events in obese adults. [1]


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