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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