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Review
. 2009 Dec;9(6):617-21; quiz 622-3.
doi: 10.7861/clinmedicine.9-6-617.

Modern management of obesity

Bhandari Sumer Aditya  1 , John P H Wilding
Affiliations
Review

Modern management of obesity

Bhandari Sumer Aditya et al. Clin Med (Lond). 2009 Dec.
No abstract available

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Figures

Fig 1(a).
Fig 1(a).
Laparoscopic adjustable gastric banding (LAGB): this is a purely restrictive procedure which involves placing an adjustable band in the upper part of the stomach, just distal to the gastro-oesophageal junction. The amount of restriction can be altered by injecting or withdrawing saline from the band through a subcutaneous port. Although this procedure has the lowest mortality risk, the weight loss achieved is lower (with lower co-morbidity improvement rate) and there is a high complication and failure rate requiring reoperation or conversion to other procedures. It is fully reversible but the success of this procedure is highly dependent on the patient's ability to stick to a healthy lifestyle and the availability of a skilled bariatric team.
Fig 1(b).
Fig 1(b).
Laparoscopic Roux-en-Y gastric bypass (RYGB): this is the most common procedure performed in the world today, which relies mainly on restriction of food intake with some degree of malabsorption. The stomach is reduced to a small upper gastric pouch which drains into a Roux-en-Y limb of proximal jejunum (variable lengths used between 75 and 150 cm). RYGB causes more weight loss than purely restrictive procedures and also causes significant improvements in obesity-related co-morbidities. Nutritional deficiencies are common and require close monitoring by a multidisciplinary team. Weight regain is a concern particularly in people who do not follow dietary advice which may require intensive lifestyle modification with behavioural therapy and possibly revisional surgery.
Fig 1(c).
Fig 1(c).
Bilio-pancreatic diversion with duodenal switch (BPD-DS): this is more complicated and a technically challenging procedure which causes weight loss mainly by malabsorption. A sleeve gastrectomy is performed (rather than the horizontal gastrectomy performed in the Scopinaro type) leaving a gastric reservoir of 150–200 ml. The duodenum is closed about 2 cm distal to the pylorus and a duodeno-ileal anastomosis is performed. The common limb is about 75–100 cm where food from the alimentary limb mixes with the biliary and pancreatic juices causing significant malabsorption. This procedure can be done in two stages in very obese subjects or patients with high mortality risk. The weight loss results are impressive with significant improvements in co-morbidities but this procedure carries a high mortality and complication risk. Protein malnutrition and nutritional deficiencies are a concern, particularly in patients who are unable to follow strict dietary changes that are required.
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References

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    1. Dansinger ML, Gleason JA, Griffith JL, Selker HP, Schaefer EJ. Comparison of the Atkins, Ornish, Weight Watchers, and Zone diets for weight loss and heart disease risk reduction: a randomized trial. JAMA 2005;293:43–53. - PubMed
    1. Paisey RB, Frost J, Harvey P. et al Five year results of a prospective very low calorie diet or conventional weight loss programme in type 2 diabetes. J Hum Nutr Diet 2002;15:121–7.10.1046/j.1365-277X.2002.00342.x - DOI - PubMed

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