The surgical management of severe obesity.

The prevalence of obesity in the United States is increasing to epidemic proportions. At present, more than 60% of Americans are overweight. While a variety of medications are available for the treatment of obesity, none results in the long-term loss of more than 10% of body weight. The current standard for the treatment of severe obesity, defined as a body mass index of greater than 35 40 kg/m 2, is surgical. Several surgical procedures are currently available, including gastric bypass, biliopancreatic diversion with duodenal switch, and the adjustable gastric band. These operations may be performed using laparoscopic surgical techniques to minimize perioperative morbidity and postoperative recovery time. To optimize the outcome of this type of procedure, bariatric surgery should be performed on carefully selected patients, in centers specially equipped to care for the obese, within a broadly based, multidisciplinary setting providing lifelong postoperative care.