Bariatrics: Wikis

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Bariatrics is the branch of medicine that deals with the causes, prevention, and treatment of obesity.[1] The term bariatrics was created around 1965,[2] from the Greek root bar- ("weight," as in barometer), suffix -iatr ("treatment," as in pediatrics), and suffix -ic ("pertaining to"). The field encompasses dieting, exercise and behavioral therapy approaches to weight loss, as well as pharmacotherapy and surgery.

Overweight and obesity are rising medical problems of pandemic proportions.[3][4] There are many detrimental health effects of obesity:[5][6] Specifically, individuals with a Body Mass Index or BMI exceeding a healthy range have a much greater risk of a wide range of medical issues.[7] These include heart disease, diabetes, many types of cancer, asthma, obstructive sleep apnea, chronic musculoskeletal problems, etc. There is also a clear effect of obesity on mortality, though this is not so clear for those who are overweight.[8]

Contents

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.[9] 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.[10] Besides these indirect methods, body fat can also be measured directly.

General aspects of treatment

People may find it difficult to lose weight on their own.[11] Indeed, it is common for dieters to have tried a variety of fad diets only to find that they return to their original weight or potentially see a weight gain after a period of time.[12]

Although diet, exercise, behavior therapy and anti-obesity drugs are first-line treatment,[10] medical therapy for severe obesity has limited short-term success and almost nonexistent long-term success.[13] 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.[14] The combination of approaches used may be tailored to each individual patient.[15].

Weight Loss Programs

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Dietary Counseling

Dietitians and nutritionists can advise patients as to what foods they should be eating to help ensure they are receiving enough vitamins and minerals. It is also important for a meal program to be formulated that satisfies the patient's caloric requirements to maintain good health while continuing to promote weight loss [16] . The diet cannot be so restrictive that the patient cannot maintain their efforts for the long term. Regular adjustment of diet plans to meet the changing needs of the patient is a key component [17].

Exercise

Exercise is important to any weight-loss program. Ramping up the patient's metabolism, burning calories, and improving the overall health of the body are all achievable through exercise [18] . Patients meet with Fitness Trainers and Exercise Physiologists who design custom programs to encourage safe exercise for each patient. As the patient progresses in physical capability these programs continue to be modified to promote maximum effectiveness without endangering the patient. Vigorous exercise is essential in helping an individual reduce the size of fat cells and to retain lean muscle mass.

Psychological Approaches

Investigating and addressing a patient's psychological state is a key component [19] . If there are psychological issues that are coming into play regarding the patient's health, they must be taken into consideration when customizing a weight loss plan for them. A positive attitude and mental focus are seen as essential to successfully achieving one's weight loss goals. Mental issues that lead a patient to engage in emotional eating or other negative behavior must be addressed. Eating behaviorists and health coaches will work with patients to help give them the tools they need to navigate this process. Occasionally, a more in depth psychological intervention is necessary. In these cases, the patient may require the help of a psychologist or psychiatrist (with the possibility of prescription drug therapy for treating mental health issues which may affect the patient's ability to adhere to the program.) [20] . Mental health is treated with equal important to physical health and they both play a role in a medical weight loss program.

Behaviorist Therapy

Patients need to learn a new set of behaviors to encourage healthier choices in their daily routine [21]. Everything from lifestyle changes to the way a patient performs seemingly basic activities such as grocery shopping, cooking, and food planning are key to the long term success of the medical weight loss program. These sustainable and rewarding new behaviors lead to a healthier body and better quality of life.

Anti-Obesity Drugs

If diet and exercise are ineffective alone, anti-obesity drugs are a choice for some patients.[22] 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.

Surgical Procedures

Before someone can become eligible for bariatric surgery, certain criteria must be met.[13] The basic criteria are an understanding of the operation and the lifestyle changes the patient will need to make, and either:[23]

  • 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

About 7% of patients were readmitted to the hospital within 6 months to treat complications specific to the bariatric procedure.

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 percent.[24][25]

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.[26] 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.[27] 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.[28]

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.[29] Procedures can be grouped in three main categories:[30]

References

  1. ^ The American Heritage Dictionary of the English Language, 4th edition, Houghton (2000): "Bariatrics" Retrieved 14 February 2006
  2. ^ Dictionary.com, based on Random House Unabridged Dictionary, Random House (2006): [1] Retrieved 15 April 2006
  3. ^ Reynolds K, He J. Epidemiology of the metabolic syndrome.Am J Med Sci 2005;330:273-9. PMID 16355011
  4. ^ 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
  5. ^ WHO factsheet on obesity
  6. ^ Bray, George A. (2004), "Medical Consequences of Obesity", Journal of Clinical Endocrinology & Metabolism 89 (6): 2583–2589, doi:10.1210/jc.2004-0535, PMID 15181027  
  7. ^ Gregg, Edward W.; Cheng, Yiling J.; Cadwell, Betsy L.; Imperatore, Ciuseppina; Williams, Desmond E.; Flegal, Katherine M.; Narayan, K. M. Venkat; Williamson, David F. (2005), "Secular Trends in Cardiovascular Disease Risk Factors According to Body Mass Index in U.S. Adults", Obstetrical & Gynecological Survey 60 (10): 660–661, doi:10.1097/01.ogx.0000180862.46088.0d  
  8. ^ Flegal KM, Graubard BI, Williamson DF, Gail MH. Excess deaths associated with underweight, overweight, and obesity. JAMA 2005; 293: 1861-7.
  9. ^ Obesity: preventing and managing the global epidemic. Geneva, World Health Organization (WHO Technical Report Series, No. 894).
  10. ^ a b 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.
  11. ^ Bagozzi, Richard P.; Moore, David J.; Leone, Luigi (2004), "Self-Control and the Self-Regulation of Dieting Decisions: the Role of Prefactual Attitudes, Subjective Norms, and Resistance to Temptation", Basic and Applied Social Psychology 26 (2-3): 199–213, doi:10.1207/s15324834basp2602&3_7  
  12. ^ Ikeda, J. (1999), "A Commentary on the New Obesity Guidelines from NIH", Journal of the American Dietetic Association 99: 918, doi:10.1016/S0002-8223(99)00218-7  
  13. ^ a b Gastrointestinal surgery for severe obesity: National Institutes of Health Consensus Development Conference Statement. Am J Clin Nutr 1992;55(S2):615S-619S. PMID 1733140
  14. ^ Colquitt J, Clegg A, Sidhu M, Royle P. Surgery for morbid obesity. Cochrane Database Syst Rev 2003; 2: CD003641. PMID 12804481
  15. ^ Gerwecka, C.A.; Krenkela, J.; Molinia, M.; Frattingera, S.; Plodkowskia, R.; Jeora, S. St (2007), "Tailoring Information to the Needs of the Individual Patient Sustains Interest in the Weight Loss Program and Increases Compliance: A Pilot Project", Journal of the American Dietetic Association 107 (8): A83, doi:10.1016/j.jada.2007.05.212  
  16. ^ Cunningham, C. (2006), "Menu Plans in a Diabetes Self-management Weight Loss Program", Journal of Nutrition Education and Behavior 38: 264, doi:10.1016/j.jneb.2006.01.013  
  17. ^ Curioni, C. C.; Louren, P. M. (2005), "Long-term weight loss after diet and exercise: a systematic review", International Journal of Obesity 29 (10): 1168, doi:10.1038/sj.ijo.0803015  
  18. ^ Donnelly, J. (2004), "The role of exercise for weight loss and maintenance", Best Practice & Research Clinical Gastroenterology 18: 1009, doi:10.1016/j.bpg.2004.06.022  
  19. ^ Finch, Emily A.; Linde, Jennifer A.; Jeffery, Robert W.; Rothman, Alexander J.; King, Christie M.; Levy, Rona L. (2005), "The effects of outcome expectations and satisfaction on weight loss and maintenance: Correlational and experimental analyses-a randomized trial", Health Psychology 24 (6): 608–616, doi:10.1037/0278-6133.24.6.608  
  20. ^ Markowitz, Sarah (2008), "Understanding the Relation Between Obesity and Depression: Causal Mechanisms and Implications for Treatment", Clinical Psychology Science and Practice 15: 1, doi:10.1111/j.1468-2850.2008.00106.x  
  21. ^ Rowland, N. (2008), "Feeding behavior, obesity, and neuroeconomics?", Physiology & Behavior 93: 97, doi:10.1016/j.physbeh.2007.08.003  
  22. ^ Bray, G. (2005), "Drug Treatment of Obesity", Psychiatric Clinics of North America 28: 193, doi:10.1016/j.psc.2004.09.009  
  23. ^ Gastrointestinal surgery for severe obesity. U.S. Department of Health and Human Services, National Institutes of Health. NIH Publication No. 04-4006, December 2004.
  24. ^ Agency for Healthcare Research and Quality: Obesity Surgery Complication Rates Higher Over Time. Press Release, July 24, 2006. Retrieved July 24, 2006
  25. ^ Encinosa WE, Bernard DM, Chen CC, Steiner CA (2006). "Healthcare utilization and outcomes after bariatric surgery" (Abstract). Medical Care 44(8): 706–12. doi:10.1097/01.mlr.0000220833.89050.ed. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&list_uids=16862031&dopt=Abstract. Retrieved 2006-08-08.  
  26. ^ 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
  27. ^ Mitka M. Surgery for obesity: demand soars amid scientific, ethical questions. JAMA 2003; 289: 1761-2.
  28. ^ Agency for Healthcare Research and Quality: AHRQ Study Finds Weight-loss Surgeries Quadrupled in Five Years. Press Release, July 12, 2005 Retrieved July 24, 2006
  29. ^ 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
  30. ^ Abell TL, Minocha A. Gastrointestinal complications of bariatric surgery: diagnosis and therapy. Am J Med Sci 2006;331: 214-8.

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