In the United States, more than one-third of the population is obese. Currently, bariatric surgery is the best known treatment for obesity, and multiple meta-analyses have shown bariatric surgery to be more effective for treating obesity than diet and exercise or pharmacologic treatment. The modern era of bariatric surgery began in 2005, which is defined by a drastic increase in the use of laparoscopy. Bariatric surgery has the potential to improve obesity-related comorbidities, such as type 2 diabetes, cardiovascular disease, and sleep apnea. The effect of bariatric surgery on weight loss and comorbidities varies by the type of procedure.
Key points
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Bariatric surgery is currently the best known treatment of obesity.
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The sleeve gastrectomy and Roux-en-Y gastric bypass are the two most popular bariatric operations.
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Bariatric surgery has the potential to improve multiple obesity-related comorbidities.
Introduction
Obesity (body mass index [BMI] ≥30 kg/m 2 ) remains a significant problem in the United States, as more than one-third of the American population is obese. Obesity’s burden on the nation’s health care system can be quantified in terms of patient health as well health economics. With respect to the former, obesity is associated with a range of health issues, including diabetes, cancer, and heart disease. Overweight-obesity is responsible for as many as 10% of deaths in America.
At present, bariatric surgery is the best known treatment of obesity, and multiple meta-analyses have shown bariatric surgery to be more effective than diet and exercise or pharmacologic treatment.
Bariatric surgery is marked by large and rapid growth over the last 2 decades. In 1998, 12,775 bariatric operations were performed in the United States. By 2004, that number increased to 135,985. The modern era of bariatric surgery began in 2005, which is defined by a drastic increase in the use of laparoscopy. Although in 2004 less than one-third of bariatric operations were performed laparoscopically, more than 97% of bariatric operations are now laparoscopic procedures.
Three main procedures dominate bariatric surgery: the gastric bypass, sleeve gastrectomy, and gastric band. At their respective peaks, the gastric bypass (in 2003) accounted for 99% of all bariatric surgeries, the gastric band (in 2008) accounted for 29% of all bariatric operations, and the sleeve gastrectomy (in 2012) accounted for 42% of all bariatric operations. Fig. 1 shows trends in the distribution of bariatric procedures over time, from 2004 to 2012.
