Bariatrics
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'''Bariatrics''' is the branch of [[medicine]] that deals with the causes, prevention, and treatment of [[obesity]].<ref name=bartleby>The American Heritage Dictionary of the English Language, 4th edition, Houghton (2000): [http://www.bartleby.com/61/84/B0078400.html "Bariatrics"] Retrieved 14 Feb. 2006</ref> The term ''bariatrics'' was created around [[1965]],<ref name=dictionary.com>Dictionary.com, based on Random House Unabridged Dictionary, Random House (2006): [http://dictionary.reference.com/browse/bariatrics] Retrieved 15 Apr. 2006</ref> from the [[Greek language|Greek]] root ''baro'' ("weight," as in [[barometer]]), [[Affix|suffix]] -''iatr'' ("treatment," as in [[pediatrics]]), and [[Affix|suffix]] -''ic'' ("pertaining to"). Besides the [[pharmacotherapy]] of obesity, it is concerned with obesity surgery.
[[Overweight]] and [[obesity]] are rising medical problems of [[pandemic]] proportions.<ref name=reynolds>Reynolds K, He J. Epidemiology of the metabolic syndrome.''Am J Med Sci'' 2005;'''330''':273-9. PMID 16355011</ref><ref name=hedley>Hedley AA, Ogden CL, Johnson CL, et al. 2004. Prevalence of overweight and obesity among US children, adolescents, and adults, 1999–2002. ''JAMA'' ; '''291''': 2847–50. PMID 15199035</ref> There are many detrimental health effects of obesity:<ref name=WHO>[http://www.who.int/hpr/NPH/docs/gs_obesity.pdf WHO factsheet on obesity]</ref> [[heart disease]], [[diabetes]], many types of [[cancer]], [[asthma]], [[obstructive sleep apnea]], chronic musculoskeletal problems, ''etc''. There is also a clear effect of obesity on [[death|mortality]], though this is not so clear for those who are overweight.<ref name=flegal>Flegal KM, Graubard BI, Williamson DF, Gail MH. Excess deaths associated with underweight, overweight, and obesity. ''JAMA'' 2005; '''293''': 1861-7.</ref>
==Diagnosis==
Although not a direct measure of [[body fat]], the [[Body Mass Index]] is widely adopted and promoted as a marker for excess body weight.<ref name=BMI>[http://www.who.int/nutrition/publications/obesity_executive_summary.pdf Obesity: preventing and managing the global epidemic. Geneva, [[World Health Organization]] (WHO Technical Report Series, No. 894).]</ref> However, it is not flawless: a very muscular person may be assessed as obese, and an elderly person with low body weight but high body fat (this can happen due to low muscle mass and bone density) may be assessed as healthy. Other markers for the evaluation of obesity include waist circumference (associated with [[central obesity]]), and a patient's risk factors for diseases and conditions associated with obesity.<ref name=guidelines>[http://www.nhlbi.nih.gov/guidelines/obesity/ob_home.htm Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults, The Evidence Report. NIH Publication NO. 98-4083, september 1998. NATIONAL INSTITUTES OF HEALTH National Heart, Lung, and Blood Institute in cooperation with The National Institute of Diabetes and Digestive and Kidney Diseases.]</ref> Besides these indirect methods, body fat can also be measured directly.
==General aspects of treatment==
Although [[dieting|diet]], [[exercise]], [[behavior therapy]] and [[anti-obesity drug]]s are first-line treatment,<ref name=guidelines>[http://www.nhlbi.nih.gov/guidelines/obesity/ob_home.htm Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults, The Evidence Report. NIH Publication NO. 98-4083, september 1998. NATIONAL INSTITUTES OF HEALTH National Heart, Lung, and Blood Institute in cooperation with The National Institute of Diabetes and Digestive and Kidney diseases.]</ref> medical therapy for severe obesity has limited short-term success and almost nonexistent long-term success.<ref name=NIH>Gastrointestinal surgery for severe obesity: National Institutes of Health Consensus Development Conference Statement. ''Am J Clin Nutr'' 1992;'''55'''(S2):615S-619S. PMID 1733140</ref> Therefore, obesity surgery (or bariatric surgery) has been a popular treatment in the war against obesity. Weight loss surgery generally results in greater weight loss than conventional treatment, and leads to improvements in [[quality of life]] and obesity related diseases such as [[hypertension]] and [[diabetes]].<ref name=cochrane>Colquitt J, Clegg A, Sidhu M, Royle P. Surgery for morbid obesity. ''Cochrane Database Syst Rev 2003''; '''2''': CD003641. PMID 12804481</ref>
Before someone can become eligible for bariatric surgery, certain criteria must be met.<ref name=NIH>Gastrointestinal surgery for severe obesity: National Institutes of Health Consensus Development Conference Statement. ''Am J Clin Nutr'' 1992;'''55'''(S2):615S-619S. PMID 1733140</ref> The basic criteria are an understanding of the operation and the lifestyle changes the patient will need to make, and either:<ref>[http://win.niddk.nih.gov/publications/gastric.htm Gastrointestinal surgery for severe obesity. U.S. Department of Health and Human Services, National Institutes of Health. NIH Publication No. 04-4006, December 2004.]</ref>
* a body mass index (BMI) of 40 or more, which is about 45 kg (100 pounds) overweight for men and 35 kg (80 pounds) for women; or
* a BMI between 35 and 39.9 and a serious obesity-related health problem such as type 2 diabetes, heart disease, or severe sleep apnea (when breathing stops for short periods during sleep)
Past studies found that 10 percent to 20 percent of bariatric surgery patients had complications while they were in the hospital. In 2006, federal researchers found that 39.6 percent of patients had complications within 180 days of surgery. The most common complications are
* a composite of [[Gastrointestinal tract|gastrointestinal]] [[symptom]]s including [[vomiting]], [[diarrhea]], [[dysphagia]], and [[Gastroesophageal reflux disease|reflux]] (20%)
* [[Surgical anastomoses|anastomotic]] leaking (at the surgical connections between the stomach and the intestine) (12%)
* abdominal [[hernia]] (7%)
* and "[[infections]]" (6%).
About 7% of patients were readmitted to the [[hospital]] within 6 months to treat complications specific to the bariatric procedure.
<P>There were 212 in-hospital deaths out of an estimated 104,702 adults who underwent obesity surgery in 2003, or a rate of 0.2 per cent.<ref>
Agency for Healthcare Research and Quality: [http://www.ahrq.gov/news/press/pr2006/obessurgpr.htm Obesity Surgery Complication Rates Higher Over Time. Press Release, July 24, 2006.] Retrieved July 24, 2006</ref><ref>{{cite journal | author = Encinosa WE, Bernard DM, Chen CC, Steiner CA | year = 2006 | title = Healthcare utilization and outcomes after bariatric surgery | journal = Medical Care | volume = 44(8) | pages = 706–12 | url = http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&list_uids=16862031&dopt=Abstract | format = Abstract | accessdate = 2006-08-08 | doi = 10.1097/01.mlr.0000220833.89050.ed }}</ref>
<P>The [[prevalence]] of extreme obesity (body mass index > or = 40 kg/m²) in the [[United States]] in [[2003]]-[[2004]] was 2.8% in men and 6.9% in women.<ref>Ogden CL, Carroll MD, Curtin LR, McDowell MA, Tabak CJ, Flegal KM. Prevalence of overweight and obesity in the United States, 1999-2004. ''JAMA'' 2006; '''295''':1549-55. PMID 16595758</ref> This suggests millions of people are in the weight range for potential therapy with bariatric surgery. [[Laparoscopic surgery]] has become an important addition to this field of surgery, and demand soars, amidst scientific and ethical questions.<ref>Mitka M. Surgery for obesity: demand soars amid scientific, [[ethics|ethical]] questions. ''JAMA'' 2003; '''289''': 1761-2.</ref> The number of Americans having weight-loss surgery more than quadrupled between 1998 and 2002—from 13,386 to 71,733—according to a study by the [[Agency for Healthcare Research and Quality]].<ref>Agency for Healthcare Research and Quality: [http://www.ahrq.gov/news/press/pr2005/wtlosspr.htm AHRQ Study Finds Weight-loss Surgeries Quadrupled in Five Years. Press Release, July 12, 2005] Retrieved July 24, 2006</ref>
==Surgical procedures==
{{main|Bariatric surgery}}
There are a number of [[surgical]] options available to treat obesity, each with their advantages and pitfalls. In general, weight reduction can be accomplished, but one must consider operative risk (including mortality) and side effects. Usually, these procedures can be carried out safely.<ref>Nguyen NT ''et al.'' Result of a national audit of bariatric surgery performed at academic centers: a 2004 University HealthSystem Consortium Benchmarking Project. ''Arch Surg'' 2006; '''141''': 445-9. PMID 16702515</ref> Procedures can be grouped in three main categories:<ref>Abell TL, Minocha A. Gastrointestinal complications of bariatric surgery: diagnosis and therapy. ''Am J Med Sci'' 2006;'''331''': 214-8.</ref>
* predominantly [[malabsorption|malabsorptive]] procedures: although also reducing stomach size, these operations are based mainly on malabsorption.
** Biliopancreatic Diversion (Scopinaro procedure - rare)
** [[Jejuno-ileal bypass]] (no longer performed)
* predominantly restrictive procedures: this kind of surgery primarily reduces stomach size
** [[Vertical banded gastroplasty surgery|Vertical Banded Gastroplasty]] (Mason procedure, stomach stapling)
** Laparoscopic [[Adjustable Gastric Band]] (LAGB)(REALIZE Band - Lap Band)
** [[Sleeve gastrectomy]]
* Mixed procedures: applying both techniques simultaneously
** [[gastric bypass surgery]], like [[Roux-en-Y]] gastric bypass
** [[Sleeve gastrectomy]] with [[Duodenal Switch]]
** [[Implantable Gastric Stimulation]]
==Anti-obesity drugs==
{{main|Anti-obesity drug}}
If diet and exercise are ineffective alone, [[anti-obesity drug]]s are a choice for some patients. Prescription weight loss drugs are recommended only for short-term use, and thus are of limited usefulness for extremely obese patients, who may need to reduce weight over months or years.
==Footnotes==
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==External links==
*[http://videos.med.wisc.edu/videoInfo.php?videoid=2236 VIDEO: How Bariatrics Has Changed Our Understanding of Type II Diabetes] Dr. Daniel McKenna speaks at the University of Wisconsin School of Medicine and Public Health, 2008.
*[http://search.nlm.nih.gov/homepage2/query?PARAMETER=gastric+bypass+surgery&FUNCTION=search&MAX=250&DISAMBIGUATION=true&SERVER2=server2&SERVER1=server1&imageField.x=22&imageField.y=13 MedLinePlus Portal on Weight Loss Surgery]
*[http://www.asmbs.org/ American Society for Metabolic & Bariatric Surgery]
*[http://www.asbp.org/ American Society for Bariatric Physicians]
[[Category:Obesity]]
[[Category:Bariatrics]]
[[Category:Medical specialties]]
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[[ru:Бариатрия]]