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Bariatric Surgery: Crossing a Body Mass Index Threshold

Thomas A. Wadden, PhD; and Adam Gilden Tsai, MD, MS
[+] Article, Author, and Disclosure Information

From the University of Pennsylvania School of Medicine, Philadelphia, PA 19104.

Grant Support: In part by a National Institutes of Health Midcareer Investigator Award in Patient-Oriented Research (K24-DK65018) (T.A. Wadden).

Potential Financial Conflicts of Interest: Consultancies: T.A. Wadden (Abbott Laboratories); Honoraria: T.A. Wadden (Abbott Laboratories, Roche [not active]); Grants received: T.A. Wadden (Abbott Laboratories).

Requests for Single Reprints: Thomas A. Wadden, PhD, University of Pennsylvania, 3535 Market Street, Suite 3029, Philadelphia, PA 19104; e-mail, wadden@mail.med.upenn.edu.

Current Author Addresses: Dr. Wadden: University of Pennsylvania, 3535 Market Street, Suite 3029, Philadelphia, PA 19104.

Dr. Tsai: University of Pennsylvania, 3535 Market Street, Suite 3024, Philadelphia, PA 19104.

Ann Intern Med. 2006;144(9):689-691. doi:10.7326/0003-4819-144-9-200605020-00013
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As many as 5% of adults in developed nations now have extreme obesity, characterized by a body mass index (BMI) of 40 kg/m2 or more (1). These individuals have a mortality rate that is at least double that of individuals with a BMI in the desirable range of 18.5 kg/m2 to 24.9 kg/m2(2). More than 40 years of research has shown that surgical intervention, particularly the gastric bypass, is the treatment of choice for extremely obese individuals who cannot control their weight with traditional methods, such as lifestyle modification or pharmacotherapy (34). Bariatric surgery also is indicated for individuals with BMIs of 35.0 kg/m2 to 39.9 kg/m2 who have comorbid conditions, including type 2 diabetes, hyperlipidemia, and sleep apnea (56). Both the gastric bypass and the newer laparoscopic adjustable gastric banding improve these conditions (34). The gastric bypass is generally considered to be the more effective of the 2 procedures, but it is associated with higher mortality than laparoscopic adjustable gastric banding (4).

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