Centennial Center for the Treatment of Obesity is in Nashville, Tennessee.

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by James N. Lau, MD, FACS; and Myriam J. Curet, MD, FACS Both are with Stanford School of Medicine, Stanford University

INTRODUCTION

Obesity is a well recognized public health epidemic affecting not only the United States, but the world. “This insidious, creeping pandemic of obesity is now engulfing the entire world,” Australia’s Monash University professor Paul Zimmet, Chair of the 10th International Congress on Obesity, said on the opening day of the conference. Mounting evidence now rates obesity, with its multiple comorbid diseases, as the second most preventable cause of death next to smoking in the US.

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by Stephanie B. Jones, MD; Jeffrey M. Ellenbogen, MD; and Daniel B. Jones, MD, FACS

Obstructive sleep apnea (OSA) is a medical condition that leads to significant morbidity and reduced quality of life.

INTRODUCTION

Obstructive sleep apnea (OSA) is a medical condition that leads to significant morbidity and reduced quality of life. Patients with OSA are particularly vulnerable to certain perioperative complications, and the incidence of OSA in the bariatric population may be as high as 77 percent.1 Therefore, the surgeon and bariatric team should routinely screen for OSA as part of the preoperative workup. In this article, we will provide a brief overview of OSA, focusing primarily on the challenges that face surgeons and anesthesiologists in handling these cases. By understanding this disorder, and how it is perturbed in the perioperative period, surgical outcomes may be considerably improved.

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by Louis O. Jeansonne IV, MD; Craig B. Morgenthal, MD; Brent C. White, MD; and Edward Lin, DO

All from Emory Endosurgery Unit, Emory University School of Medicine

Laparoscopic Roux-en-Y gastric bypass (LGBP) has been shown to be an effective treatment for morbid obesity, both in terms of weight loss and improvement in multiple comorbidities. 1 While the laparoscopic approach offers many advantages to the patient in terms of fewer wound complications, decreased length of hospital stay, and decreased postoperative pain, certain complications of this operation continue to pose difficult clinical problems as the number of procedures performed increases. One such complication is internal hernia through one of the mesenteric defects, which can result in small bowel obstruction, ischemia, or infarction and often requires reoperation.
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by Louis J. Aronne, MD, FACP, and Kathy Keenan Isoldi, MS, RD, CDE

The increased prevalence of obesity has undoubtedly been influenced by a multitude of factors. Some factors are obvious, such as an increased consumption of calories and decreased usage of energy. There are, however, more subtle instigators in the development of obesity. For example, sleep debt, a shift in the population’s ethnic composition, and medications, among other factors, have shown an association with the increased body weight of our population.1 Scientists have recently presented data suggesting two new, unconventional culprits that may affect weight gain.2,3 The type of microbes that inhabit the human gut and exposure to certain viruses have emerged as potential catalysts in the development of obesity.2,4

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Interviewed by Kelvin Higa, MD, FACS

The US experience with the jejunoileal (J-I) bypass was bittersweet. It was an effective weight loss and metabolic instrument, but the side effects, complications, and nutritional consequences gave us a healthy respect for malabsorption. I was recently invited to the Società Italiana di Chirurgia dell’Obesità in Florence, Italy, celebrating the 30th anniversary of the biliopancreatic diversion (BPD). As I am intrigued by the European interest in the gastric bypass and possess great admiration for Professor Scopinaro, I accepted the great honor of interviewing him on this subject. The following represents an annotated conversation that actually began over six years ago between Dr. Scopinaro and myself, and serves as a reflection for those of us in the field of bariatric surgery today who enjoy delving into the history and ideology behind some of its biggest developments. -Kelvin Higa, MD, FACS

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INTRODUCTION

As professionals in the field of weight loss surgery, it is crucial that we continue to explore the impact of the addiction factor after bariatric surgical procedures. Further, we must educate patients and families on the possibility of transferring from one type of unhealthy behavior (excessive consumption of food) to other forms of behavior that can lead a patient down an unhealthy path. The addiction factor is by no means limited to excessive food or alcohol consumption; it can show up as uncontrolled spending, drug-related difficulties, smoking, sexual promiscuity, or compulsive gambling. In fact, virtually any behavior exhibited in excess can interfere with the goals of a comprehensive bariatric surgery program.

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To what do you attribute the growth of obesity in our population?

Dr. Wittgrove: Obesity is such a complex disease. It is certainly rooted in genetics, but there are so many environmental issues that influence the overall expression of the genetic potential. The fact that we are less active and have more carbohydrates in our diet does not help. I believe that if you are so genetically encoded and you get about 40 percent over your ideal body weight, you no longer have the physiologic feedback of satiety and that makes it impossible (or nearly impossible) to stay on a diet unless you receive the tool of surgical intervention.

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