Obesity: surgical management

Bariatric surgery is a treatment approach for patients for whom multiple attempts at weight loss through lifestyle interventions and/or pharmacotherapy have not been successful. Surgery for obesity management produces greater weight loss than medical therapy alone. Four procedures frequently covered by health insurance are laparoscopic adjustable gastric band, Roux-en-Y gastric bypass, laparoscopic vertical sleeve gastrectomy, and biliopancreatic diversion with or without duodenal switch. Current indications for bariatric surgery include a body mass index of 40 kg/m(2) or greater or a body mass index of 35 kg/m(2) or greater with at least one major obesity-associated comorbid condition. Expected weight loss can range from 37% to 79% of excess weight at 2 years after surgery depending on the procedure. Patients must commit to lifelong adherence to dietary supplementation and monitoring of vitamin levels, because nutritional deficiencies are common.