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Surgical approaches to the treatment of obesity

Nature Reviews Gastroenterology & Hepatology volume 8, pages 429–437 (2011)Cite this article

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Abstract

Bariatric surgery, through its efficacy and improved safety, is emerging as an important and broadly available treatment for people with severe and complex obesity that has not responded adequately to other therapy. Established procedures, such as Roux-en-Y gastric bypass and adjustable gastric banding, account for more than 80% of bariatric surgical procedures globally. Sleeve gastrectomy has emerged as a stand-alone procedure. Truly malabsoptive procedures, such as biliopancreatic diversion and its duodenal switch variant, have a diminishing role as primary procedures, but remain an option for patients who do not respond adequately to less disruptive procedures. The procedures vary considerably in their postoperative morbidity and mortality; pattern and extent of weight loss; nature and severity of long-term complications; and nutritional requirements and risks. There is no perfect procedure—an informed risk and benefit assessment should be made by each patient. Gastroenterologists also need to be familiar with the risks and benefits of current and emerging procedures as they are likely to be increasingly involved in the integrated care of these patients.

Key Points

  • Bariatric surgery has an established role in achieving sustained weight loss, improving obesity-related conditions and saving lives

  • During the past decade there has been a major increase in the use of bariatric surgery and a reduction in postoperative morbidity and mortality

  • There is no perfect bariatric procedure; selection is based on local availability, the balance of risks and benefits for an individual, and ultimately patient choice

  • The nature of bariatric surgery places the gastroenterologist on the front line for detecting and evaluating surgical complications

  • Interventions to the gut can lead to major changes in energy balance and metabolism; future research will be guided by an improved understanding of the mechanisms involved

  • Gastroenterologists will be increasingly involved in the development and implementation of a range of novel endoluminal bariatric and metabolic procedures

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Figure 1: The four established bariatric surgical procedures.
Figure 2: Obesity, especially central or abdominal obesity, and weight gain generate a complex metabolic, inflammatory and physical cascade that lead through a number of pathways to the more serious conditions associated with obesity.

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Acknowledgements

We acknowledge the help of Toni McGee in reviewing, editing and preparing the manuscript for submission.

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  1. Baker IDI Heart & Diabetes Institute, PO Box 6492 St. Kilda Road Central, Melbourne, 3004, Vic, Australia

    John B. Dixon, Nora E. Straznicky, Elisabeth A. Lambert, Markus P. Schlaich & Gavin W. Lambert

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J. B. Dixon and G. W. Lambert contributed to all aspects of this manuscript. M. P. Schlaich contributed to the research, discussion of content and editing of the manuscript. N. E. Straznicky and E. A. Lambert contributed to the discussion of content and editing of the manuscript.

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Correspondence to John B. Dixon.

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All authors receive research support from Abbott Pharmaceuticals, Allergan Inc., Ardian, Inc. and Scientific Intake. J. B. Dixon is a consultant for Allergan Inc., Metagenics and Scientific Intake, and is on the Medical Advisory Board for Optifast (Nestle Australia). M. P. Schlaich is on the Scientific Advisory Board for Abbott and Novartis.

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Dixon, J., Straznicky, N., Lambert, E. et al. Surgical approaches to the treatment of obesity. Nat Rev Gastroenterol Hepatol 8, 429–437 (2011). https://doi.org/10.1038/nrgastro.2011.112

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