Bariatric surgery. Indications - operative options - limits

Every fifth German is obese, which means that 20% of male and 21.1% of female adults have a BMI of more than 30. In total 1.02 million adults in Germany are morbidly obese (BMI>40). This pandemic situation of obesity and morbid obesity is similar to the incidence of obesity in North America. In consideration of the increasing incidence of obesity the long-term success rate of conservative obesity treatment of 1-2% does not ease this situation. Widespread prevention programs are not planned. The current only, as well long-term, effective therapy against morbid obesity is bariatric surgery. There is an arsenal of restrictive (e.g. gastric band, gastric sleeve) and combinations of restrictive and malabsorptive procedures (Roux-en-Y gastric bypass, biliopancreatic diversion) available to treat morbid obesity. Bariatric surgery can not only induce excess weight loss of 75-80% but also a remission of co-morbidities, such as type 2 diabetes mellitus or metabolic syndrome. Even the tremendously reduced life expectancy of morbidly obese patients could be adapted to normal weight subjects by bariatric surgery.