Bariatric surgery for morbid obesity

A 44-year-old obese woman (height, 1.7 m [65 in.]) has seen her primary care physician for the past 10 years for management of conditions related to her obesity, including diabetes, hypertension, and gastroesophageal reflux disease. Despite efforts to lose weight, her body weight has increased from 109 to 127 kg (240 to 280 lb), and her body-mass index (BMI) - the weight in kilograms divided by the square of the height in meters - from 40.0 to 46.6. During a routine office visit, the patient asks her physician whether bariatric surgery might be a treatment option for her. The physician does not recommend referral for surgical evaluation, citing concerns about the variable effectiveness of the procedure and the associated risks, as well as the lack of long-term outcome data. The patient then seeks a specialist in bariatric surgery for evaluation, without the assistance of her physician. Copyright © 2007 Massachusetts Medical Society.