Role of the Gastroenterologist in Managing Obesity

John K DiBaise; Amy E Foxx-Orenstein


Expert Rev Gastroenterol Hepatol. 2013;7(5):439-451. 

In This Article

Expert Commentary and Five-Year View

Obesity is a complex condition of many causes that often leads to poor medical and psychological health and premature death, with those affected suffering enormous social stigma and discrimination. Alarmingly, the prevalence of overweight and obesity in children and adolescents is on the rise, with similar-to-adult disease states developing at younger and younger ages. The diseases associated with obesity are responsible for a substantial amount of direct and indirect healthcare costs. The magnitude of the obesity epidemic, coupled with our understanding of gut hormones in appetite and weight regulation and the role of the gut microbiome in metabolism, points to a clear role for gastroenterologists. Indeed, gastroenterologists are on the front line in diagnosing and treating patients with a range of digestive diseases and complications directly related to obesity. Beyond the increased demand for endoscopic and other GI procedures in obese individuals and the preoperative and postoperative care of the bariatric patient, gastroenterologists are uniquely positioned to be involved in the primary treatment of obesity. The recent approval of two medications provides new options in the clinical management of overweight and obese patients. Bariatric surgery has an important role in the treatment of severe and medically complicated obesity. Gastroenterologists must be familiar with these pharmacological and surgical options including their indications, risks, benefits and potential complications, as they will be increasingly involved in the integrated care of these patients. Furthermore, although bariatric surgery remains the most effective and durable treatment of obesity, endoluminal interventions including prostheses, stapling and suturing hold promise for an ambulatory procedure that may be safer and more cost-effective. In this regard, the technological advances that have been made are exciting; however, the safety and efficacy of these devices ultimately need to be proven within appropriately designed clinical trials. A reversible endoluminal approach will be particularly appealing as it will not entail a permanent modification of the GI tract. Although these devices should be held to similar standards as available operative techniques, the goal may vary depending upon the intent of the procedure as a primary, bridge or metabolic therapy.