Department of General Surgery, York Hospital, York, UK.
Postgrad Med J. 2013 Jul;89(1053):411-6; quiz 415, 416. doi: 10.1136/postgradmedj-2012-131310. Epub 2013 Mar 7.
Obesity has become an increasingly important health problem over the past 30 years. Presently around a quarter of the UK adult population are obese and this figure is set to increase further in the coming decades. The health consequences of obesity on multiple body systems have been well established as has the financial cost of the condition to both the individuals affected as well as to society as a whole. Bariatric surgery has been shown to be the only long term effective solution in terms of sustained weight loss and comorbidity resolution. The commonest bariatric procedure in the UK is the Roux-en-y gastric bypass which consistently results in the loss of 70%-80% of excess bodyweight. Results however are variable and in order to optimise resource allocation and avoid exposing patients unlikely to benefit from surgery to its inherent risks, much research has been done to try to identify those patients most likely to obtain a good result. The only factor which has been subjected to meta-analysis is that of preoperative weight loss which shows a positive association with postoperative weight loss following bypass surgery. Although the remaining data are not based on level 1 evidence those other preoperatively identifiable factors which are associated with an improved outcome include Caucasian or Hispanic ethnicity, higher educational status, non-shift-work working patterns, female gender and divorced or single marital status. Similarly increased levels of preoperative physical activity and an absence of binge eating behaviour are consistent with a favourable result whereas increased age, smoking and other socioeconomic factors have not been shown to have a significant impact. Conversely diabetes mellitus seems to have a slight negative correlation with postoperative weight loss; however, a history of sexual abuse or psychiatric illness has not been shown to have a lasting influence.
在过去的 30 年中，肥胖已成为一个日益严重的健康问题。目前，英国约有四分之一的成年人口肥胖，这一数字在未来几十年还将进一步上升。肥胖对多个身体系统的健康后果以及该疾病对个人和整个社会造成的经济成本已经得到充分证实。减重手术已被证明是长期有效解决持续减重和并发症解决的唯一方法。在英国，最常见的减重手术是 Roux-en-y 胃旁路手术，该手术可使超重体重的 70%-80%得到持续减轻。然而，结果因人而异，为了优化资源分配并避免将不太可能从手术中获益的患者暴露在手术的固有风险下，已经进行了大量研究试图确定最有可能获得良好结果的患者。唯一经过荟萃分析的因素是术前减重，它与旁路手术后的术后减重呈正相关。尽管其余数据不是基于一级证据，但与手术结果改善相关的其他术前可识别因素包括白种人或西班牙裔种族、较高的教育程度、非轮班工作模式、女性性别和离婚或单身的婚姻状况。同样，术前较高的身体活动水平和没有暴食行为与良好的结果一致，而年龄增加、吸烟和其他社会经济因素则没有显示出显著影响。相反，糖尿病似乎与术后减重有轻微的负相关；然而，性虐待或精神疾病史并未显示出持久的影响。
