Management of morbid obesity - The Journal of Family Practice

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Management of morbid obesity: The role of bariatric surgery Management of morbid obesity: Publication date: March 2005 Expiration date: March 2006 Learning objectives: Upon completion of this program, participants should be able to: ■ Place bariatric surgery in the context of overall management of obesity The role of bariatric surgery ■ Identify and refer patients who may be candidates for bariatric surgery ■ Advise patients on the benefits and risks associated with various bariatric surgical procedures, as well as the long-term commitment required ■ Participate in preoperative assessment and treatment, if indicated ■ Participate in postoperative management and follow-up Sponsorship The University of Cincinnati College of Medicine designates this educational activity for a maximum of 2.5 category 1 credits toward the AMA Physician’s Recognition Award. Each physician should claim only those hours that he/she actually spent on the activity. This CME activity has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the University of Cincinnati College of Medicine and Dowden Health Media. The University of Cincinnati College of Medicine is accredited by the ACCME to provide continuing medical education for physicians. Audience Family physicians and other primary care practitioners. Acknowledgment: This CME activity is supported by an unrestricted educational grant from Ethicon Endo-Surgery, Inc. Faculty Disclosures ■ Dr Sheperd reports no financial relationship with any company whose products are mentioned in this supplement. ■ Drs Buchwald and Still serve as consultants to Ethicon Endo- Surgery, Inc. COPYRIGHT © 2005 BY DOWDEN HEALTH MEDIA, MONTVALE, NJ 2 Supplement to The Journal of Family Practice March 2005 Bariatric surgery in context . . . . . . . . . . . . . . . . . . 3 Todd M. Sheperd, MD Assistant Clinical Professor Department of Family Medicine Michigan State University College of Human Medicine Traverse City, Mich Surgical options . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 Henry Buchwald, MD, PhD Professor, Department of Surgery Owen H. and Sarah Davidson Wangensteen Chair in Experimental Surgery Emeritus University of Minnesota Medical School Minneapolis, Minn Before and after surgery: The team approach to management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 Christopher D. Still, DO Director, Center for Nutrition and Weight Management Geisinger Health Care System Danville, Pa CME posttest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 CME registration form and program evaluation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
Bariatric surgery in context Todd M. Sheperd, MD Assistant Clinical Professor Department of Family Medicine Michigan State University College of Human Medicine Traverse City, Mich Obesity is now pandemic in the United States and other industrialized countries (FIGURE 1), 1-3 the result by and large of a combination of inappropriate diets and inadequate exercise. And the problem is no longer confined to industrialized countries. Rapid Westernization of diet and lifestyle among urban dwellers in India, China, and elsewhere has been followed by an alarming rise in obesity-related health problems. 4,5 The morbidly obese patient presents a particular challenge because of the massive weight loss that needs to be achieved. It was for this patient that bariatric surgery was first proposed in the 1950s, leading to emergence of a surgical specialty that last year performed more than 140,000 operations in the United States. As Henry Buchwald will discuss in the next article, the safety and efficacy of bariatric surgical techniques have improved over the years and a substantial body of evidence has been accumulated. The clinician often is reluctant to consider bariatric surgery as an option even though nonsurgical treatments for severe obesity remain far from ideal. When all available options for managing morbid obesity are compared, it is difficult to dismiss operative therapy as a viable consideration. Startling statistics Obesity is defined as a body mass index (BMI) greater than 30 kg/m 2 . The pre-obesity or overweight stage includes BMIs of at least 25 kg/m 2 but less than 30 kg/m 2 . Patients with BMIs greater than 40 kg/m 2 are considered to be extremely or morbidly obese (class III obesity), as are those with BMIs greater than 37 kg/m 2 and obesityrelated comorbidity. 6 Although other measures of obesity are available, BMI is easily determined; moreover, it is THE JOURNAL OF FAMILY PRACTICE used as the standard for weight determination in the majority of clinical studies of obesity. 7 On basis of these BMI criteria, approximately 65% of adults in the United States are overweight, and 31%—an 8% increase in 1 decade—are obese. 1 More than 15% of adolescents are overweight, up from about 5% in the early 1970s (FIGURE 2). 7 In the last 10 to 15 years, the average BMI of the US population has increased from 24.9 to 26.5 kg/m 2 . 8 The prevalence of class III obesity rose even faster—today, an estimated 2.2% to 4.7% of Americans are morbidly obese. 1,2,8 The prevalence is particularly high among US women, 6.3% of whom are now morbidly obese, while among non-Hispanic black women the rate is now 15%. 1 Using data from the Behavioral Risk Factor Surveillance System, Sturm calculated that the prevalence of BMIs of 40 kg/m 2 and higher quadrupled between 1986 and 2000, while the prevalence of BMIs of 50 kg/m 2 and higher—the heaviest Americans—increased by a factor of 5. 9 When obesity remains untreated Left untreated, obesity is implicated in the development of multiple comorbidities including hypertension, type 2 diabetes, coronary artery disease, osteoarthritis, and some types of cancer (TABLE 1). 10,11 Because most of these diseases are correlated directly with BMI, 10,12 the patient with class III obesity is most likely to have them. Not surprisingly, obesity also is associated with increased risk of mortality—it contributes directly to approximately 280,000 deaths per year. 13 Even though class III patients represent a minority of the obese population, mortality in this subgroup is disproportionately high (relative risk, 1.9-2.6). 13,14 Recent analyses have estimated that in 2000, March 2005 Supplement to The Journal of Family Practice 3
Page 1: Free 2.5 CME credits Management of
Page 5 and 6: in their normal-weight counterparts
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Page 27 and 28: Registration form (please print) NA

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