INTRODUCTION

INTRODUCTION

Obesity is defined as body mass index (BMI) >30 kg/m2. Obesity is

increasing in prevalence worldwide. The economic costs of obesity are
staggering. Obesity and its complications lead to other significant costs,
such as missed days of work and a decrease in life expectancy. Similar
trends have been reported in other parts of the world. (Singh, et al, 2007)

Body mass index (BMI) is considered to represent the most

practical measure of a person's adiposity. It is calculated by dividing the
weight in kilograms by the height in meters squared (kg/m2). In adults, a
BMI of:

25 to 29.9 kg/m2 is considered overweight

30 to 34.9 kg/m2 is considered obese (class I obesity)

35 to 39.9 kg/m2 is considered moderately obese (class II obesity)

40 to 49.9 kg/m2 is considered severely or extremely obese (class

III obesity)

>50.0 kg/m2 is considered super obese (class IV obesity). (Ludwig

et al,2009)

Bariatric surgical procedures effect weight loss through two

fundamental mechanisms: 1) malabsorption and 2) restriction . Some
procedures have both a restrictive and malabsorptive component. There is
also growing recognition that bariatric surgical procedures contribute to
neurohormonal effects on the regulation of energy balance. (Roth et al,
2009)

INTRODUCTION
Open or laparoscopic Vertical banded gastroplasty (VBG) and
laparoscopic adjustable gastric banding (LAGB) are purely restrictive
procedures, Jejunoileal bypass (JIB) and the duodenal switch operation
(DS) are examples of malabsorptive procedures.The Roux-en-Y gastric
bypass (RYGB), the biliopancreatic diversion (BPD) and BPD with
duodenal switch (BPD/DS) are both restrictive and malabsorptive. (Roth
et al, 2009)
The goal of surgery is to reduce the morbidity and mortality
associated with obesity, and to improve metabolic and organ function.
Several studies have demonstrated that bariatric surgery is effective in
reducing obesity-related comorbidities, while having additional benefits
such as reducing monthly medication costs and the number of sick days,
and improving quality of life. (Christou et al, 2004)
A significant reduction in overall and cause-specific mortality has
also been clearly demonstrated. The reduction in comorbidities appears to
translate into a 29 percent reduction in mortality. (Sjostrom et al, 2007)
Indications for the surgical management of severe obesity were first
outlined by the National Institutes of Health (NIH) Consensus
Development Panel in 1991 potentially eligible patients should:

Be well-informed and motivated

Have a BMI >40

Have acceptable risk for surgery

Have failed previous nonsurgical weight loss

The NIH also suggested that adults with a BMI >35 who have
serious comorbidities such as diabetes, sleep apnea, obesity-related
cardiomyopathy, or severe joint disease may also be candidates.
(NIH CONSENSUS 1991)

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Contraindications to bariatric surgery include patients with
untreated major depression or psychosis, binge-eating disorders, current
drug and alcohol abuse, severe cardiac disease with prohibitive anesthetic
risks, severe coagulopathy, or inability to comply with nutritional
requirements including life-long vitamin replacement. Bariatric surgery in
advanced (above 65) or very young age (under 18) is controversial, but is
considered when comorbidity is severe. (Yermilov et al,2009)