St. Louis, MO, April 12, 2010 More than one third of Americans are considered obese and approximately 15 million (5%) Americans now have a body mass index (BMI) greater than 40. The April issue of the Journal of the American Dietetic Association focuses on the ever-increasing use of bariatric surgery to control the excess morbidity and mortality associated with extreme obesity and the important role that registered dietitians play in the management of patients who have undergone the procedure.
In their editorial on bariatric surgery, Robert K. Kushner, MD; and Lisa M. Neff, MD, Northwestern University Feinberg School of Medicine, Chicago, compare leading approaches and offer insights into their strengths and weaknesses. They advocate treatment by a multidisciplinary team of experts including physicians, exercise specialists, behaviorists and registered dietitians, with a focus on lifestyle modification to help patients achieve weight loss, with or without pharmacotherapy as an adjunctive treatment. When these approaches fail to produce clinically significant weight loss, bariatric surgery should be considered for patients with a BMI over 40 (or over 35 in the presence of significant weight-related conditions such as diabetes or hypertension).
Bariatric surgeon Alex Nagle, MD, FACS, Feinberg School of Medicine at Northwestern Memorial Hospital, Chicago, summarizes the key rationale for the increase in bariatric surgery. While concerns remain about long-term safety and future risk for other diseases, the opportunity to halt and reverse the increasing weight gain has tremendous appeal. He cites to efforts by the American Society of Metabolic & Bariatric Surgery and the American College of Surgeons to improve both patient access and overall quality of care, through the establishment of bariatric surgery Centers of Excellence. According to Dr. Nagle, this constitutes "an important step forward toward accurately tracking outcomes, defining
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Elsevier Health Sciences