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Surgical intervention as a strategy for treatment of obesity

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Abstract

A very large number of weight-reducing surgical techniques have been developed over the last 25 years. Today only a handful of these techniques can be recommended. Gastric bypass, vertical banded gastroplasty, and variable banding can all be recommended although gastric bypass should be reserved for heavier patients. For the heaviest, biliopancreatic diversion or biliopancreatic diversion with duodenal switch might be considered. The controlled intervention study Swedish Obse Subjects has shown that most but not all cardiovascular risk factors are improved over 10 years by surgically induced weight loss. Quality of life as well as cardiac structure and function are dramatically improved. The average weight loss for gastric bypass and vertical banded gastroplasty was 16% after 10 years. No non-surgical treatment available today can achieve such results, not even over 2 years. Surgical treatment for obesity needs to become much more common, particularly in obese patients with metabolic disturbances.

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References

  1. Stunkard, A. J. and McLaren-Hume, M. (1959). Arch. Intern. Med. 79, 103.

    Google Scholar 

  2. Sohar, E. and Sneh, E. (1973). Am. J. Clin. Nutr. 26, 845–848.

    PubMed  CAS  Google Scholar 

  3. Sjöström, C. D., Lissner, L., Wedel, H., and Sjöström, L. (1999). Obes. Res. 7, 477–484.

    PubMed  Google Scholar 

  4. Sjöström, C. D., Peltonen, M., Wedel, H., and Sjöström, L. (2000). Hypertension, 36, 20–25.

    PubMed  Google Scholar 

  5. Deitel, M. (1989). Surgery for the morbidly obesepatient. Lea & Febiger: Philadelphia.

    Google Scholar 

  6. Sjöström, L. (2000) In: International textbook of obesity, Björntorp, P. (ed.). Wiley: London, in press.

    Google Scholar 

  7. Payne, J. H., DeWind, L. T., and Commons, R. R. (1963). Am. J. Surg. 106, 273–289.

    Article  PubMed  CAS  Google Scholar 

  8. DeWind, L. T. and Payne, J. H. (1976). JAMA 236, 2298–2301.

    Article  PubMed  CAS  Google Scholar 

  9. Scott, H. W. Jr., Dean, R. H., Shull, H. J., and Gluck, F. (1977). Surg. Gynecol. Obstet. 145, 661–673.

    PubMed  Google Scholar 

  10. Palmer, J. A. (1980). In: Nutrition in clinical surgery. Dietal, M. (ed.). Williams & Williams: Baltimore.

    Google Scholar 

  11. Eriksson F. (1981). Int. J. Obes. 5, 437–447.

    PubMed  CAS  Google Scholar 

  12. Pace, W. G., Martin, E. W., Jr., Tetirick, T., Fabri, P. J., and Carey, L. C. (1979). Ann. Surg. 190, 392–400.

    Article  PubMed  CAS  Google Scholar 

  13. Pories, W. J., Flickinger, E. G., Meelheim, D., Van Rij, A. M., and Thomas, F. T. (1982). Ann. Surg. 196, 389–399.

    Article  PubMed  CAS  Google Scholar 

  14. Näslund, I. (1986). Acta Chir. Scand. 152, 205–210.

    PubMed  Google Scholar 

  15. Gomez, C. A. (1979). Surg. Clin. North Am. 59, 1113–1120.

    PubMed  CAS  Google Scholar 

  16. Kuzmark, L. I. (1989). In: Surgery for the morbidly obese patient. Deitel, M. (ed.) Lea & Febiger: Philadelphia.

    Google Scholar 

  17. Bö, O. and Modalsli, O. (1983). Int. J. Obes. 7, 493–499.

    PubMed  Google Scholar 

  18. Solhaug, J. H. (1983). Curr. Surg. 40, 424–428.

    PubMed  CAS  Google Scholar 

  19. Kuzmark, L. I. (1991). Obes. Surg. 1, 403–408.

    Article  Google Scholar 

  20. Forsell, P., Hallberg, D., and Hellers, G. (1993). Obes. Surg. 3, 369–374.

    Article  PubMed  Google Scholar 

  21. Hallerbäck, B. J. (1995). Int. Surg. 80, 307–310.

    PubMed  Google Scholar 

  22. Hallerbäck, B., Glise, H., Johansson, B., and Johnson, E. (1998). Eur. J. Surg. Suppl. 582, 128–131.

    PubMed  Google Scholar 

  23. Dargent, J. (1999). Obes. Surg. 9, 446–452.

    Article  PubMed  CAS  Google Scholar 

  24. Mason, E. E. (1987). Arch. Surg. 117, 701–706.

    Google Scholar 

  25. Mason, E. E. (1987). Surg. Clin. North Am. 67, 521–537.

    PubMed  CAS  Google Scholar 

  26. Eckhout, G. V., Willbanks, O. L., and Moore, J. T. (1986). Am. J. Surg. 152, 713–716.

    Article  PubMed  CAS  Google Scholar 

  27. Fobi, M. A. and Lee, H. (1994). J. Natl. Med. Assoc. 86, 125–128.

    PubMed  CAS  Google Scholar 

  28. Mason, E. E. and Ito, C. (1967). Surg. Clin. North Am. 47, 1345–1351.

    PubMed  CAS  Google Scholar 

  29. Mason, E. E. and Ito, C. (1969). Ann. Surg. 170, 329–339.

    Article  PubMed  CAS  Google Scholar 

  30. Alden, J. F. (1977). Arch. Surg. 112, 799–806.

    PubMed  CAS  Google Scholar 

  31. Griffen, W. O., Jr., Young, V. L., and Stevenson, C. C. (1977). Ann. Surg. 186, 500–509.

    Article  PubMed  Google Scholar 

  32. Griffen, W. O., Jr., Bivins, B. A., Bell, R. M., and Jackson, K. A. (1981). World J. Surg. 5, 817–822.

    Article  PubMed  Google Scholar 

  33. Torres, J. C., Oca, C. F., and Garrison, R. N. (1983). South Med J. 76, 1217–1221.

    PubMed  CAS  Google Scholar 

  34. Torres, J. C. and Oca, C. (1987). Bariatr. Surg. 5, 10–15.

    Google Scholar 

  35. Fobi, M. A. and Fleming, A. W. (1986). J. Natl. Med. Assoc. 78, 1091–1098.

    PubMed  CAS  Google Scholar 

  36. Scopinaro, N., Gianetta, E., Civalleri, D., Bonalumi, U., and Bachi, V. (1979). Br. J. Surg. 66, 613,617.

    Article  PubMed  CAS  Google Scholar 

  37. Scopinaro, N., Gianetta, E., Civalleri, D. Bonalumi, U., and Bachi, V. (1979). Br. J. Surg. 66, 618–620.

    Article  PubMed  CAS  Google Scholar 

  38. Jordan, J. H., Hocking, M. P., Rout, W. R., and Woodward, E. R. (1991). Am. Surg. 57, 286–288.

    PubMed  CAS  Google Scholar 

  39. Hess, D. S. (1994). Obes. Surg. 4, 105 (abstract).

    Article  Google Scholar 

  40. Marceau, P., Biron, S., and Bourque, R. (1993). Obes. Surg. 3, 29–36.

    Article  PubMed  Google Scholar 

  41. Baltasar, A., Bou, R., and Cipapauta, L. (1995). Obes. Surg. 5, 419–423.

    Article  PubMed  Google Scholar 

  42. Fried, M., and Peskova, M. (1997). Hepatogastroenterology 44, 582–587.

    PubMed  CAS  Google Scholar 

  43. Ballesta-Lopez, C., Bastida-Vila, X., Catarci, M., Bettonica-Larranaga, C., and Zaraca, F. (1998). Hepatogastroenterology 45, 2447–2452.

    PubMed  CAS  Google Scholar 

  44. Abu-Abeid, S. and Szold, A. (1999). Obes. Surg. 9 188–190.

    Article  PubMed  CAS  Google Scholar 

  45. O'Brien, P. E., Brown, W. A., Smith, A., McMurrick, P. J., and Stephens, M. (1999). Br. J. Surg. 86, 113–118.

    Article  PubMed  Google Scholar 

  46. Kunath, U., Susewind, M., Klein, S., and Hofmann, T. (1998). Chirurg. 69, 180–185.

    Article  PubMed  CAS  Google Scholar 

  47. Dumont, L., Mattys, M., Mardirosoff, C., Picard, V., Alle, J. L., and Massaut, J. (1997). Obes. Surg. 7, 326–331.

    Article  PubMed  CAS  Google Scholar 

  48. Dumont, L., Mattys, M., Mardirosoff, C., Vervloesem, N., Alle, J. L., and Massaut, J. (1997). Acta Anaesthesiol. Scand. 41, 408–413.

    Article  PubMed  CAS  Google Scholar 

  49. Lönroth, H., Dalenbäck, J. Haglind, E., et al. (1996). Surg. Laparosc. Endosc. 6, 102–107.

    Article  PubMed  Google Scholar 

  50. Lönroth, H., Dalenbäck, J., Haglind, E., and Lundell, L. (1996). Surg. Endosc. 10, 636–638.

    Article  PubMed  Google Scholar 

  51. Cagigas, J. C., Martino, E., Escalante, C. F., et al. (1999). Obes. Surg. 9, 166–170.

    Article  PubMed  CAS  Google Scholar 

  52. Lewis, L. A., Turnbull, R. B. Jr., and Page, I. H. (1966). Arch. Intern. Med. 117, 4–16.

    Article  PubMed  CAS  Google Scholar 

  53. Shibata, H. R., MacKenzie, J. R., and Long, R. C. (1967). Arch. Surg. 95, 413–428.

    PubMed  CAS  Google Scholar 

  54. Rucker, R. D. Jr., Goldenberg, F., Varco, R. L., and Buchwald, H. (1981). J. Surg. Res. 30, 229–235.

    Article  PubMed  Google Scholar 

  55. Deitel, M., Bojm, M. A., Atin, M. D., and Zakhary, G. S. (1982). Can. J. Surg. 25, 283–289.

    PubMed  CAS  Google Scholar 

  56. O'Leary, J. P. (1992). Am. J. Clin. Nutr. 55, 567S-570S.

    PubMed  Google Scholar 

  57. Laws, H. L. and Piantadosi, S. (1981). Ann. Surg. 193, 334–340.

    Article  PubMed  CAS  Google Scholar 

  58. Lechner, G. W. and Callender, A. K. (1981). Surgery 90, 637–644.

    PubMed  CAS  Google Scholar 

  59. Lechner, G. W. and Elliott, D. W. (1983). Arch. Surg. 118, 685–692.

    PubMed  CAS  Google Scholar 

  60. Näslund, I., Wickbom, G., Christoffersson, E., and Ågren, G. (1986). Acta Chir. Scand. 152, 681–689.

    PubMed  Google Scholar 

  61. Näslund, I. (1987). Acta Chir. Scand. Suppl. 536, 1–60.

    PubMed  Google Scholar 

  62. Hall, J. C., Watts, J. M., O'Brien, P. E., et al. (1990). Ann. Surg. 211, 419–427.

    Article  PubMed  CAS  Google Scholar 

  63. Backman, L. and Granström, L. (1984). Acta Chir. Scand. 150, 63–67.

    PubMed  CAS  Google Scholar 

  64. Linner, J. H. (1982). Arch. Surg. 117, 695–700.

    PubMed  CAS  Google Scholar 

  65. Sugerman, H. J. and Wolper, J. L. (1984). Am. J. Surg. 148, 331–336.

    Article  PubMed  CAS  Google Scholar 

  66. Gleysteen, J. J. (1987). Gastroenterol. Clin. North Am. 16, 525–527.

    PubMed  CAS  Google Scholar 

  67. Lindroos, A. K., Lissner, L., and Sjöström, L. (1996). Int. J. Obes. Relat. Metab. Disord. 20, 634–643.

    PubMed  CAS  Google Scholar 

  68. Flancbaum, L., Choban, P. S., Bradley, L. R., and Burge, J. C. (1997). Surgery 122, 943–949.

    Article  PubMed  CAS  Google Scholar 

  69. Mason, E. E. (1999). Obes. Surg. 9, 223–228.

    Article  PubMed  CAS  Google Scholar 

  70. Orskov, C., Poulsen, S. S., Moller, M., and Holst, J. J. (1996). Diabetes 45, 832–835.

    Article  PubMed  CAS  Google Scholar 

  71. Sugerman, H. J., Starkey, J. V., and Birkenhauer, R. (1987). Ann. Surg. 205, 613–624.

    Article  PubMed  CAS  Google Scholar 

  72. MacLean, L. D., Rhode, B. M., Sampalis, J., and Forse, R. A. (1993). Am. J. Surg. 165, 155–160; discussion 160–162.

    Article  PubMed  CAS  Google Scholar 

  73. Mason, E. E., Doherty, C., Maher, J. W., Scott, D. H., Rodriguez, E. M., and Blommers, T. J. (1987). Gastroenterol. Clin. North Am. 16, 495–502.

    PubMed  CAS  Google Scholar 

  74. Lönroth, H. and Dalenbäck, J. (1998). World J. Surg. 22, 964–968.

    Article  PubMed  Google Scholar 

  75. Sugerman, H. J., Londrey, G. L., Kellum, J. M., et al. (1989). Am. J. Surg. 157, 93–102.

    Article  PubMed  CAS  Google Scholar 

  76. Näslund, I. (1998). Int. J. Obes. 22, S52.

    Google Scholar 

  77. Miller, K., and Hell, E. (1999). Obes. Sur. 9, 183–187.

    Article  CAS  Google Scholar 

  78. Juvin, P., Marmuse, J. P., Delerme, S., et al. (1999). Eur. J. Anaesthesiol. 16, 400–403.

    Article  PubMed  CAS  Google Scholar 

  79. Fried, M., Peskova, M., and Kasalicky, M. (1998). Obes. Surg. 8, 45–48.

    Article  PubMed  CAS  Google Scholar 

  80. Suter, M., Giusti, V., Heraief, E., Jayet, C., and Jayet, A. (1999). Obes. Surg. 9, 374–380.

    Article  PubMed  CAS  Google Scholar 

  81. Belachew, M., Legrand, M., Vincent, V., Lismonde, M., Le Docte, N., and Deschamps, V. (1998). World J. Surg. 22, 955–963.

    Article  PubMed  CAS  Google Scholar 

  82. Doherty, C., Maher, J. W., and Heitshusen, D. S. (1999). Eur. J. Gastroenterol. Hepatol. 11, 115–119.

    Article  PubMed  CAS  Google Scholar 

  83. Chelala, E., Cadiere, G. B., Favretti, F., Himpens, J., Vertruyen, M., Bruyns, J., et al. (1997). Surg. Endosc. 11, 268–271.

    Article  PubMed  CAS  Google Scholar 

  84. Näslund, E., Freedman, J., Lagergren, J., Stockeld, D., and Granström, L. (1999). Obes. Surg. 9, 369–373.

    Article  PubMed  Google Scholar 

  85. Scopinaro, N., Giametta, E., Adami, G. F., et al. (1996). Surgery 119, 261–268.

    Article  PubMed  CAS  Google Scholar 

  86. Scopinaro, N., Adami, G. F., Marinari, G. M., et al. (1998). World J. Surg. 22, 936–946.

    Article  PubMed  CAS  Google Scholar 

  87. Nanni, G., Balduzzi, G. F., Capoluongo, R., et al. (1997). Obes. Surg. 7, 26–29.

    Article  PubMed  CAS  Google Scholar 

  88. Noya, G., Cossu, M. L., Coppola, M., et al. (1998). Obes. Surg. 8, 61–66.

    Article  PubMed  CAS  Google Scholar 

  89. Totte, E., Hendrickx, L., and van Hee, R. (1999). Obes. Surg. 9, 161–165.

    Article  PubMed  CAS  Google Scholar 

  90. Chapin, B. L., LeMar, H. J., Jr., Knodel, D. H., and Carter, P. (1996). Arch. Surg. 131, 1048–1052.

    PubMed  CAS  Google Scholar 

  91. Brolin, R. E., and Leung, M. (1999). Obes. Surg. 9, 150–154.

    Article  PubMed  CAS  Google Scholar 

  92. Marceau, P., Hould, F. S., Simard, S., et al. (1998). World J. Surg. 22, 947–954.

    Article  PubMed  CAS  Google Scholar 

  93. Rabkin, R. A. (1998). Obes. Surg. 8, 53–59.

    Article  PubMed  CAS  Google Scholar 

  94. Hess, D. S. and Hess, D. W. (1998). Obes. Surg. 8, 267–282.

    Article  PubMed  CAS  Google Scholar 

  95. NIH. (1992). Am. J. Clin. Nutr. 55, 615S-619S.

    Google Scholar 

  96. The Danish Obesity Project. (1979). Lancet 2, 1255–1258.

    Google Scholar 

  97. Stokholm, K. H., Nielsen, P. E., and Quaade F. (1982). Int. J. Obes. 6, 307–312.

    PubMed  CAS  Google Scholar 

  98. Andersen, T., Backer, O. G., Stokholm, K. H., and Quaade, F. (1984). N. Engl. J. Med. 310, 352–356.

    Article  PubMed  CAS  Google Scholar 

  99. Andersen, T., Stokholm, K. H., Backer, O. G., and Quaade, F. (1988). Int. J. Obes. 12, 277–284.

    PubMed  CAS  Google Scholar 

  100. Martin, L. F., Tan, T. L., Horn, J. R., et al. (1995). Surgery 118, 599–606; discussion 7.

    Article  PubMed  CAS  Google Scholar 

  101. Sjöström, L., Larsson, B., Backman, L., et al. (1992). Int. J. Obes. Relat. Metab. Disord. 16, 465–479.

    PubMed  Google Scholar 

  102. Karason, K., Lindroos, A. K., Stenlöf, K., and Sjöström, L. (2000). Arch. Intern. Med. 160, 1797–1802.

    Article  PubMed  CAS  Google Scholar 

  103. Lindroos, A. K., Lissner, L., and Sjöström, L. (1993). Eur. J. Clin. Nutr. 47, 461–481.

    PubMed  CAS  Google Scholar 

  104. Lindroos, A. K., Lissner, L., and Sjöström, L. (1993). Eur. J. Clin. Nutr. 53, 375–378.

    Article  Google Scholar 

  105. Sjöström, C. D., Håkangård, A. C., Lissner, L., and Sjöström, L. (1995). Obes. Res. 3, 9–22.

    PubMed  Google Scholar 

  106. Sjöström, C. D., Lissner, L., and Sjöström, L. (1997). Obes. Res. 5, 519–530.

    PubMed  Google Scholar 

  107. Sjöström, L., Rissanen, A., Andersen, T., et al. (1998). Lancet 352, 167–172.

    Article  PubMed  Google Scholar 

  108. Wadden, T. A., Anderson, D. A., and Foster, G. D. (1999). Obes. Res. 7, 170–178.

    PubMed  CAS  Google Scholar 

  109. Sjöström, C. D. (2000). PhD thesis, Göteborg University, Göteborg, Sweden, pp 1–87.

  110. Pamuk, E. R., Williamson, D. F., Serdula, M. K., Madans, J., and Byers, T. E. (1993). Ann. Intern. Med. 119, 744–748.

    PubMed  CAS  Google Scholar 

  111. Williamson, D. F., Pamuk, E., Thun, M., Flanders, D., Byers, T., and Heath, C. (1995). Am. J. Epidemiol. 141, 1128–1141 (published erratum appears in Am. J. Epidemiol. 1995:42:369).

    PubMed  CAS  Google Scholar 

  112. Williamson, D. F., Pamuk, E., Thun, M., Flanders, D., Heath, C., and Byers, T. (1997). Obes. Res. 5, 94 (abstract)

    Google Scholar 

  113. Jacobson, P., Lindroos, A. K., Sjöström, C. D., and Sjöström, L. (2000). Int. J. Obes. 24(Suppl 1), 5175.

    Google Scholar 

  114. Moghadasian, M. H., McManus, B. M., and Frohlich, J. J. (1997). Arch. Intern. Med. 157, 2299–2308 (published erratum appears in Arch. Intern. Med. 1998 158, 662).

    Article  PubMed  CAS  Google Scholar 

  115. Karason, K., Wallentin, I., Larsson, B., and Sjöström, L. (1997). BMJ 315, 912–916.

    PubMed  CAS  Google Scholar 

  116. Karason, K., Wallentin, I., Larsson, B., and Sjöström, L. (1998). Obes. Res. 6, 422–429.

    PubMed  CAS  Google Scholar 

  117. Karason, K., Molgaard, H., Wikstrand, J., and Sjöström, L. (1999). Am. J. Cardiol. 83, 1242–1247.

    Article  PubMed  CAS  Google Scholar 

  118. Karason, K., Wikstrand, J., Sjöström, L., and Wendelhag, I. (1999). Int. J. Obes. Relat. Metab. Disord. 23, 948–956.

    Article  PubMed  CAS  Google Scholar 

  119. Nichols, W. W., and O'Rourke, M. F. (1998). McDonald's blood flow in arteries. Lea & Febiger: Philadelphia.

    Google Scholar 

  120. Boutouyrie, P., Bussy, C., Lacolley, P., Girerd, X., Laloux, B., and Laurent, S. (1999). Circulation 100, 1387–1393.

    PubMed  CAS  Google Scholar 

  121. Franklin, S. S., Khan, S. A., Wong, N. D., Larson, M. G., and Levy, D. (1999). Circulation 100, 354–360.

    PubMed  CAS  Google Scholar 

  122. Narbro, K., Jonsson, E., Waaler, H., Wedel, H., and Sjöström, L. (1994). Int. J Obes. 18, 14 (abstr.)

    Google Scholar 

  123. Sjöström, L., Narbro, K., and Sjöström, D. (1995). Int. J. Obes. Relat. Metab. Disord. 19, S9-S12.

    PubMed  Google Scholar 

  124. Narbro, K., Jonsson, E., Larsson, B., Waaler, H., Wedel, H., and Sjöström, L. (1996). Int. J. Obes. Relat. Metab. Disord. 20, 895–903.

    PubMed  CAS  Google Scholar 

  125. Narbo, K., Ågren, G., Jonsson, E., et al. (1999). Int. J. Obes. 23, 619–24.

    Article  Google Scholar 

  126. Narbro, K., Ågren, G., Näslund, I., Sjöström, L., and Peltonen, M. (2000). Int. J. Obes., 24(Suppl 1), 542 (abstract).

    Google Scholar 

  127. Sullivan, M., Karlsson, J., Sjöström, L., et al. (1993). Int. J. Obes. Relat. Metab. Disord. 17, 503–512.

    PubMed  CAS  Google Scholar 

  128. Karlsson, J., Sjöström, L., and Sullivan, M. (1995). J. Clin. Epidemiol. 48, 817–823.

    Article  PubMed  CAS  Google Scholar 

  129. Karlsson, J., Sjöström, L., and Sullivan, M. (1998). Int. J. Obes. Relat. Metab. Disord. 22, 113–26.

    Article  PubMed  CAS  Google Scholar 

  130. Sullivan, M., Karlsson, J., Sjöström, L., and Taft, C. (2000). In: International textbook of obesity. Björntorp, P. (ed.). John Wiley and Sons: London, in press.

    Google Scholar 

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Sjöström, L. Surgical intervention as a strategy for treatment of obesity. Endocr 13, 213–230 (2000). https://doi.org/10.1385/ENDO:13:2:213

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