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Medical and surgical options in the treatment of severe obesity
Abstract
Weight loss programs, diets, and drug therapy have not shown long-term effectiveness in treating morbid obesity. A 1992 statement from the National Institutes of Health Consensus Development Conference affirmed the superiority of surgical over nonsurgical approaches to this condition. Bariatric surgical procedures work in 1 of 2 ways: by restricting a patient's ability to eat (restrictive procedures) or by interfering with ingested nutrient absorption (malabsorptive procedures). Many of these procedures can be performed by a laparoscopic approach, which has been shown to reduce operative morbidity. In the United States, the primary operative choice for morbidly obese patients has recently shifted from vertical banded gastroplasty (VBG) to the Roux-en-Y gastric bypass (RYGBP). VBG, a purely restrictive procedure, has fallen into disfavor because of inadequate long-term weight loss. RYGBP combines restriction and malabsorption principles, and has been shown to induce greater weight loss than VBG. Other procedures currently being offered include laparoscopic adjustable gastric banding; biliopancreatic diversion (BPD), including the duodenal switch (BPD-DS) variation; and distal gastric bypass (DGBP). Laparoscopic adjustable gastric banding with the LAP-BAND system (INAMED Health, Santa Barbara, CA), a restrictive procedure involving placement of a silicone band around the upper stomach, was introduced in the early 1990s and approved by the US Food and Drug Administration for use in the United States in June 2001. Outside the United States, LAP-BAND surgery is the most commonly performed operation for severe obesity. The BPD, BPD-DS, and DGBP are all malabsorptive procedures offered primarily by laparotomy. They have been shown to induce good long-term weight loss but have a higher rate of adverse nutritional complications. Many safe and effective surgical options for severe obesity are available. More scientific appraisals comparing different procedures and open and laparoscopic approaches are needed.
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“Traditional behavioral strategies incorporating diet, physical activity, and behavioral modification, although effective in the short term, are generally not successful in maintaining weight loss in the long term and are not effective in patients with severe obesity.4”
From A Mindfulness-Based Intervention to Control Weight After Bariatric Surgery: Preliminary Results From a Randomized Controlled Pilot Trial (2016) · cites this paper as [4]
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Metadata
- Authors
- Fisher, B. L., & Schauer, P.
- Affiliations
- University of Nevada, Las Vegas (US)
- University of Pittsburgh (US)
- Corresponding author
- Fisher, Barry L
- ORCID
- Schauer, Philip
- Venue
- The American Journal of Surgery
- Publisher
- Elsevier BV
- Published
- 2002-12
- Volume
- 184
- Issue
- 6
- Pages
- S9-S16
- ISSN
- 0002-9610 (ISSN-L)
- OpenAlex
- W2156722534
- Cited by
- 316
- References
- 70
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 3 · 2023: 4 · 2022: 3 · 2021: 7 · 2020: 9 · 2019: 9 · 2018: 8 · 2017: 11 · 2016: 9 · 2015: 9 · 2014: 16 · 2013: 22 · 2012: 26
- FWCI
- 3.65
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The American Journal of Surgery (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Bariatric Surgery and Outcomes
- Health Sciences › Medicine › Surgery › Body Contouring and Surgery
- Health Sciences › Medicine › Surgery › Minimally Invasive Surgical Techniques
- Keywords
- morbid obesity, bariatric surgery, restrictive practices, malabsorptive surgery, Roux-en-Y gastric bypass, vertical banded gastroplasty, laparoscopic adjustable gastric banding, biliopancreatic diversion, duodenal switch, laparoscopic surgery, weight loss, nutritional complications
- MeSH terms
- Diet, Reducing, Humans, Obesity, Morbid, Laparoscopy, Gastroplasty, Exercise, Risk Assessment, Anti-Obesity Agents
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