MORBID OBESITY
AMHE 2010 Convention
Chateau Montebello
Yvan Ducheine MD
310 Central Avenue
East Orange NJ 07018
Obesity & Surgery
GOALS & OBJECTIVES:
 Definition
 Prevalence
 Impact
 Associated Illnesses
 Treatments (Surgical & Non-Surgical)
 Eligible Candidates
 Results of Surgery
Obesity & Surgery
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DEFINITION:
National Institutes of Health
Anyone with a body mass index of 30 or above
is considered obese. A body mass index
above 40 is considered morbidly obese.
Obesity & Surgery
PREVALENCE:
 Worldwide: 1.7 Billion
 1.5 to 2 times higher in women
 USA 34% of Americans
 6% Morbidly Obese
 60% to 80% of African Americans (BET)
 Children 17%-33%
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Obesity & Surgery
It is the 2nd most preventable cause of
death after smoking
 Decrease life expectancy (2.4 years)
 Increased in co-morbid illnesses
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Obesity & Surgery
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Hypertension
Diabetes
Asthma
Sleep Apnea
Hyperlipidemia
Arthritis
Infertility
Venous Stasis
Depression
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Greater Cancer Risk
Breast Cancer
Colon Cancer
Endometrial Cancer
*All cancers except
pancreatic cancer &
prostate cancer
Obesity & Surgery
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TREATMENT OPTIONS
Medicine 18% vs Surgery 30% to 80%
J Am Coll Surg. 2003 Mar;196(3):379-84.
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A comparison of diet and exercise therapy versus
laparoscopic Roux-en-Y gastric bypass surgery for morbid
obesity: a decision analysis model.
Patterson EJ, Urbach DR, Swanstrom LL.
Department of Minimally Invasive Surgery, Legacy Health
System, Portland, OR, USA.
CONCLUSIONS: In a decision analysis model, laparoscopic
gastric bypass surgery for morbid obesity was associated with a
substantially longer survival than diet and exercise therapy.
Copyright 2003 by the American College of Surgeons
Obesity & Surgery
BARIATRIC SURGERY WORLDWIDE
 Only effective therapy for morbid obesity
 2002-2003 146,301Bariatric surgeries
 2839 Bariatric Surgeons
 103,000 operations done in USA/Canada,
increased to 112K (2007-08).
 37.15% open, 65.85% laparoscopic
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Obesity & Surgery
ELIGIBILITY CRITERIA FOR SURGERY
 Acceptable Medical Risk for Surgery
 Failed attempts @ non-surgical weight
reductions (Diet & Exercise)
 BMI>40;
 BMI> 35 with obesity related comorbidities
 No Psychiatric Contraindications
 Realistic Commitment and Expectations
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Obesity & Surgery
FOOD ADDICTION
 Psychological Component
 Physical Component
 Group Therapy & Support
BEHAVIOR MODIFICATION
 Eat 3 times per day
 No Snacking Between Meals (Water Only)
 No Eating after 7:00 pm
LIFESTYLE CHANGES
 Walk one half hour per day (Continuous)
Obesity & Surgery
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GASTRIC BANDING
Restrictive
30% to 40%
Avoidance of
gastrointestinal
anastomosis
Less Invasive
Less Nutritional Px.
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GASTRIC BYPASS
Malabsorptive
70%-80%
Greater Weight Loss
More Invasive
Increased risk of
nutritional deficiencies
Obesity & Surgery
LAP-BAND System
Obesity & Surgery
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GASTRIC BYPASS
Roux-en-Y Gastric Bypass
Obesity & Surgery
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SURGICAL
COMPLICATIONS
Infections
Strictures
Intestinal Leaks
Nausea & Vomiting
Hernia
Obstruction
Death <1%
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METABOLIC
COMPLICATIONS
Nutritional
Deficiencies
Anemia
Bone Disease
Neuropathy
Vit. A Deficiency
Vit. D Deficiency
Obesity & Surgery
RESULTS:
 Hypertension 62-73% Cured
 Diabetes Mellitus 75-85% Cured
 Sleep Apnea 90% Cured
 GERD 90% Cured
 Dyslipidemia 34% Cured (38% improved)
 Hypertension & Dyslipidemia = @ 10 yrs.
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Obesity & Surgery
RESULTS:
 Dramatic Reduction in Weight
 Marked Quality of Life Improvement
Depression, Self-esteem, eating
pathology,
Obesity & Surgery
RESULTS: (Non-Compliance with Behavior & Exercise)
 Depression 12%
 Sexual Concerns 4%
 Relationship Problems 2% (>90%)
 Medical Complications due to Surgery 9%
 Lack of Exercise Being the Most Likely
Area of Non-Compliance
Obesity & Surgery
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Obesity
Prevalence (34% to 50%)
Co-morbidities
Eligible Candidates (BMI 35+ or BMI >40)
Types of Bariatric Surgeries
Success Rate in Weight Loss
Success in Curing Diabetes, Hypertension
Complications
Change in Quality of Life and Life Expectancy
Obesity & Surgery
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Cameron, JL: Current Therapy in Surgery 8th Edition
Seidell JC. Epidemiology of obesity.
Mason ME, Jalagani H, Vinik AI Metabolic complications of bariatric surgery: diagnosis and management
issues. Gastroenterol Clin North Am. 2005 Mar;34(1):25-33.
Buchwald H, Williams SE Bariatric surgery worldwide 2003. Obes Surg. 2004 Oct;14(9):1157-64.
Elkins G, Whitfield P, Marcus J, Symmonds R, Rodriguez J, Cook T. Noncompliance with behavioral
recommendations following bariatric surgery.
Dymek MP, le Grange D, Neven K, Alverdy J Quality of life and psychosocial adjustment in patients after
Roux-en-Y gastric bypass: a brief report. Obes Surg. 2001 Feb;11(1):32-9.
White S, Brooks E, Jurikova L, Stubbs RS Long-term outcomes after gastric bypass. Obes Surg. 2005
Feb;15(2):155-63.
Sjostrom L, Lindroos AK, Peltonen M, Torgerson J, Bouchard C, Carlsson B, Dahlgren S, Larsson B,
Narbro K, Sjostrom CD, Sullivan M, Wedel H; Swedish Obese Subjects Study Scientific Group Lifestyle,
diabetes, and cardiovascular risk factors 10 years after bariatric surgery. N Engl J Med. 2005 Apr
7;352(14):1495-6; author reply 1495-6.
Patterson EJ, Urbach DR, Swanstrom LL. comparison of diet and exercise therapy versus laparoscopic
Roux-en-Y gastric bypass surgery for morbid obesity: a decision analysis model. J Am Coll Surg. 2003
Mar;196(3):379-84.
Craig BM, Tseng DS. Cost-effectiveness of gastric bypass for severe obesity.
Am J Med. 2002 Oct 15;113(6):491-8.
Fang J. The cost-effectiveness of bariatric surgery Am J Gastroenterol. 2003 Sep;98(9):2097-8.