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Oct+4+Obesity+Working+Copy - OBESITY LECTURE 3 October 4...

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OBESITY LECTURE 3 October 4, 2010
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Bariatric Surgery
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Selection of Potential Patients Financial (insurance…) Psychological screening BMI Co-morbidities Age Adults Adolescents Children – still experimental   Elderly – not traditionally done
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History & Future  Bariatric Surgery Kreman & Linder Nutrient malabsorption in dogs Lose weight when bypass much of intestine Can’t remove significant amounts of adipose tissue One patient NIH – 1991 consensus conference Current status “Advanced well beyond experimental stage” 1992 (n=16,000) to 2009 (almost 220,000) Metabolic  & Bariatric  Surgery (ASMBS ) i.e. resolves type 2 diabetes within days of surgery  Poires) ????treatment for type 2 diabetes????
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Children & Adolescents Obese Adolescents (O’Bryan, 2010) Greater weight loss and greater reduction  in metabolic syndrome NIH funded TEEN Study  Longitudinal Severely obese Children (?) Small number Outcome????
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Current & Future  Standard of Care Special Hospital team High volume centers Bariatric Surgery Centers of Excellent  (ASMBS)   Main accepted centers for insurance coverage  New Criteria under discussion Disease status BMI & waist circumference Age (insufficient data)
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Types 3 Main Categories  1. Restrictive : primarily reduce size of  stomach 2.Malabsorptive : bypassing s. intestine; 
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