الفهرس 
Pathophysiology of morbid obesityOnly 14 pages are availabe for public view
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Abstract
O
besity is the second leading cause of preventable death in the United States, currently outranked only by smoking.
Obesity is a disease, and as such is in many respects not preventable. The components of this disease likely include a combination of environmental and genetic factors. The recent rapid rise in the incidence of obesity in less than a generation’s time suggests that genetic causes alone cannot be responsible for the disease. Nevertheless, the multifactorial contributions to the disease increase the difficulty in understanding its causes.
The degrees of obesity are defined by body mass index, or BMI (calculated as weight in kilograms divided by height in meters squared), which correlates body weight with height. Patients are classified as overweight, obese, or severely obese (sometimes referred to as morbidly obese)
Significant comorbidities, defined as medical problems associated with or caused by obesity, are numerous.
Diet, physical exercise or medical therapy has not proved to be efficient in treating morbid obesity in the long term.
Surgical therapy is the only effective and proven therapy for patients with severe obesity (body mass index of ≥35 kg/m2). Bariatric operations prolong survival and resolve comorbid medical conditions associated with severe obesity.
Bariatric surgery is also metabolic surgery, treating the varied metabolic consequences of the comorbid diseases arising from severe obesity. Some operations are particularly effective treatments for such metabolic consequences, such as gastric bypass for type 2 diabetes.
Bariatric operations involve either restriction of caloric intake or malabsorption of nutrients, or both. Long-term follow-up is essential before the merits of an operation can be confirmed.
The availability of a laparoscopic approach for bariatric operations caused major changes in the field, including a major increase in the number of procedures performed as well as an increased public and professional awareness and understanding of the field.
Malabsorptive operations are highly effective in producing durable weight loss but have considerable nutritional side effects. Patients undergoing such procedures require close follow-up and must take appropriate nutri-tional supplements.
Duodenal switch is an operation to be performed by skillful bariatric surgeons acquainted with all nutritional issues, aware that the postoperative care is for life, well trained in open and laparoscopic approaches, and sustained by a multidisciplinary team.
It is one of the most difficult bariatric procedures, and if done, laparoscopically is one of the most difficult operations as well.
When DS is used for revision operation, it becomes a defeat for the bariatric surgeon.
Finally, we need to remember that there is always the right patient for the right surgery. It has not been determined so far how to “fit” the patient to the “right size” operation.
Compliance, however, is responsible many times for the suc-cess or bad results of a bariatric procedure.
The patient who does not understand the importance of, or cannot afford, having correct protein intake is prone to develop severe protein malnutrition. A similar situation is created by inadequate replacements of vitamins, minerals, and other nutrients. If a patient is to benefit from weight loss surgery, he or she has to realize that there will be a cost for it.
Tolerance and acceptance for some side effects is very important.
The cost and benefit analysis needs to be perfectly un-derstood preoperatively in order to guarantee good or at least acceptable results from a bariatric operation.
Compliance is a prime condition for a patient yet to undergo malabsorptive procedure.
The socioeconomic status and eating habits of the patient do interfere many times with the end results.
All bariatric operations are tools that serve to allow the patient to lose weight, become healthier, and improve quality of life. These changes are maintained long term especially if the patient permanently adopts the new eating patterns and exercise habits that are taught and expected in the early year(s) after surgery.