Obesity is associated with multiple...

Obesity is associated with multiple morbid conditions and a los in life expectancy. Neither diet nor pharmacologic therapy is particularly effective; however, bariatric surgery is an additional treatment option. Buchwald and colleagues not away the first systematic review of the impact of bariatric surgery onward comorbid conditions, in particular, diabetes, hyperlipidemia, hypertension, and obstructive doze apnea.

Studies reporting issues of comorbid conditions after bariatric surgery were extracted. Weight los and safety data also were examined. issue time points were assessed when issues were available for at least 50 percent of the patient population in the studies.

Weight los ranged from 475 to 701 percent depending in succession the surgical technique used. Seventy-six percent or more of patients with diabetes had improvement or resolution of diabetes, depending forward the study endpoint. Resolution was defined as discontinued ne for diabetes medications and normalization of children glucose levels. Patients with diabetes had significantly greater reductions in hemoglobin A1C and fasting grape-sugar levels after bariatric surgery than did patients without diabetes. This general intent was greatest for biliopancreatic diversion or duodenal switch processs Hyperlipidemia improved regardless of step type, with significant decreases in total cholesterol and low-density lipoprotein flats Hypertension resolved in 61.7 percent of the total surgical population and resolv or improved in 785 percent irrespective of surgical performance Significant improvements also were noted in nap apnea, with 83.6 percent resolving or improving in the total population. Mortality as measured at 30 days or les after surgery was 01 to 11 percent depending onward the procedure.

The authors' systematic review reveals that multiple morbidities improve or reduce in the majority of patients undergoing bariatric surgery According to individual large study, the overall rate of mortality after nine years was 9 percent in the surgical clump compared with 28 percent in the repress group. With some morbidities, specifically diabetes, the original of bariatric surgery made a difference in issues Operative mortality was comparable with that of patients undergoing other major surgeries.

Buchwald H et al. Bariatric surgery: a systematic review and meta-analysis. JAMA October 13 2004;292;1724-37

EDITOR'S NOTE: Ultimately, preventive measures carry the highest sense of possible fulfilment for managing obesity at the lowest outlay Meanwhile, this review shows that bariatric surgery is far more effective in treating obesity than diet, exercise, or pharmacologic management. Because of the high rate of morbidity and increased mortality associated with epidemic horizontals of obesity, a cost-benefit analysis is likely to favor surgical intervention. For those who are not candidates for bariatric surgery recommendations for conventional weight los goals are 10 percent of visible form [i]or[/i] frame weight. Patients should be told that a 10-kg (22-lb) weight los ends in multiple health benefits, including decreased angina, lower children pressure, and lower lipid and family sugar levels. The results, however, will not be nearly as dramatic as those cited here.--C.W.

COPYRIGHT 2005 American Academy of Family Physicians

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