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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by Robin Blackstone, MD, FACS;
David Engstrom, PhD;
and Lisa Rivera, MPH

INTRODUCTION
Bariatric surgery is achieving increasing acceptance for the treatment of obesity. Obesity-and its role as the central paradigm of modern disease- is slowly penetrating into the consciousness of affected people, and they are increasingly hopeful of remission or cure from their medical problems through bariatric surgery. Primary care doctors, convinced by the positive results they see in patients treated with surgery, are more likely to refer their patients. Finally, payers at all levels are slowly beginning to appreciate there may be some long-term health and financial benefits. It is expected that the Medicare decision to cover surgical treatment for the indication of morbid obesity in their national coverage decision of February, 2006, will create additional pressure on payers and employers to cover these procedures. The publicity surrounding the laparoscopic gastric bypass on Carnie Wilson, widely publicized in People magazine in 1999, has also helped fuel an exponential growth in the number of procedures. The American Society for Bariatric Surgery (ASBS) has estimated that over 177,000 bariatric operations were performed in 2006.

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