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Surgical Treatment for Obesity and Morbidly Obese
Bariatric Weight Loss Surgery to Reduce Class 3 Obesity
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Surgical Treatment for Obesity

Does medical therapy have a role in the morbidly obese?

Non-Surgical Treatment of Obesity
Bariatric surgeons would argue that non-surgical treatment of the morbidly obese (BMI >40) is often futile, because the weight loss resulting from surgery is so much more dramatic than that achieved by medical treatment. However, modest weight loss in less obese individuals produces beneficial changes in blood pressure and lipids. Is it really necessary to achieve 'surgical' weight loss in order to reap health benefits? Do drugs work as well in the morbidly obese? What is the best use of healthcare resource in this very overweight group?

There is surprisingly little published evidence to help us answer these questions This lecture explores whether weight loss alone is the most appropriate clinical end-point to judge 'successful' treatment outcome and questions whether more subtle clinical and economic analyses might allow the relative merits of medical and surgical demands on healthcare resource to be considered in a more balanced way.

Weight Loss Surgery & Obesity
The conclusion drawn is that firmly held medical and surgical beliefs have a very weak evidence base. Imperfect analyses do seem to indicate that surgery is the more cost-effective treatment of severe obesity, particularly when improvements in quality of life are considered. However, many important questions remain unanswered. A well-designed long-term prospective comparison of surgical and non-surgical therapy in morbid obesity is urgently needed to inform the debate amongst healthcare purchasers attempting to tackle the consequences of the obesity epidemic.

Source: Mr David Kerrigan, Consultant Surgeon, University Hospital Aintree, Liverpool, UK.

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