Chapter 15 – Morbid Obesity

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1、CHAPTER15MORBIDOBESITYWilliamO.RichardsOBESITY:MAGNITUDEOFTHEPROBLEMobesity:magnitudeoftheproblemMorbidobesityisdefinedasbeing100lbaboveidealbodyweight,pathophysiologyandassociatedmedicalproblemstwiceidealbodyweight,orabodymassindex(BMI,whichismedicalversussurgicaltherapyweight[inkg]/height[

2、inm2])of40kg/m2.Thelatterdefinitionpreoperativeconsiderationsismoreacceptedinternationallyandhasessentiallyreplacedtheoperativeproceduresformeronesforallpracticalandscientificpurposes.Aconsensuspostoperativecareandfollow-upconferencebytheNationalInstitutesofHealth(NIH)in1991outcomessuggested

3、thatthetermsevereobesityismoreappropriatefordefin-1complicationsingpeopleofthissize.Thistermshallbeusedinterchangeablyreoperativesurgerywithmorbidobesityintheremainderofthischapter.ItisestimatedthatmorethanonethirdoftheU.S.adultadditionalconsiderationspopulationisobese;theprevalenceofmorbidl

4、yobeseadultsconclusionwithaBMIof40orhigherhasgonefrom2.9%in1994to5.9%oftheadultU.S.populationintheNationalHealthand2NutritionExaminationSurvey(NHANES)in2006.PatientsundergoingbariatricsurgeryintheUnitedStateshaveaverageThesurgicaltreatmentofmorbidobesityistermedbariatricBMIsthataresignifican

5、tlyhigherthanthosereportedinEurope.surgery.Ithaditsorigininthe1950s,whenmalabsorptiveopera-Australia,however,isnotfarbehind,accordingtoAustraliantionswerefirstperformedforseverehyperlipidemiasyndromes.bariatricsurgeons.EvenEurope,whereseverelyobeseindividu-Subsequently,jejunoilealbypasstopro

6、duceweightlossbegantoalsarenotcommonincrowds,isnowexperiencinganoverallbeperformedsporadicallyduringthe1960sandthenmoreenlargementofitspopulation.Studiesofadolescentobesityhavefrequentlyinthe1970s.Thisoperation,however,producedestimatedtheincidenceofobesity(40%aboveidealbodyunacceptablemetab

7、oliccomplicationsandhasbeencompletelyweight)asbeinginthe35%rangeforadolescentsintheUnitedabandoned;othereffective,low-morbidityoperationshavebeenStatesbutmorethan20%inmostEuropeancountries.Thedeveloped.problemisalsogrowingatanalarminglyrapidrateint