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Obesity Surgery

, Volume 19, Issue 5, pp 641–644 | Cite as

Referral for a Bariatric Surgical Consultation: It is Time to Set a Standard of Care

  • John B. DixonEmail author
New Concepts

Abstract

Indications for bariatric surgery have been clear for some time and many would say that they are conservative. Unfortunately few eligible candidates seek or are referred for bariatric surgery, with less than 1% currently treated annually. In recent years, the evidence base supporting surgical therapy has strengthened with demonstrable improvements in both safety and efficacy. We now have evidence of remarkable improvements in health, quality of life, and increased life expectancy. There is continued frustration with the poor efficacy of non-surgical therapies and no indication that this is about to change. A caring physician should, as best care, refer the seriously ill morbidly obese patient for a surgical opinion. It is no different from their obligation to adequately manage type-2 diabetes, depression or unstable angina. Currently, even discussion of a surgical referral is optional. It is time we articulated and defined a group of patients where referral for a surgical opinion is no longer merely an option but a physician’s responsibility as best care for the patient. It is time to provide leadership towards the delivery of better care for these patients.

Keywords

Comorbidity Primary care Clinical pathways Diabetes Sleep Steatosis Hypertension Hypoventilation Obesity Care 

References

  1. 1.
    Hubbard VS, Hall WH. Gastrointestinal surgery for severe obesity. Obes Surg. 1991;1:257–65.CrossRefGoogle Scholar
  2. 2.
    Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. Jama 2004;292:1724–37.CrossRefGoogle Scholar
  3. 3.
    Dixon JB, Dixon ME, O’Brien PE. Quality of life after lap-band placement: influence of time, weight loss, and comorbidities. Obes Res. 2001;9:713–21.CrossRefGoogle Scholar
  4. 4.
    Mamplekou E, Komesidou V, Bissias C, et al. Psychological condition and quality of life in patients with morbid obesity before and after surgical weight loss. Obes Surg. 2005;15:1177–84.CrossRefGoogle Scholar
  5. 5.
    Dixon JB, Dixon ME, O’Brien PE. Body image: appearance orientation and evaluation in the severely obese. Changes with weight loss. Obes Surg. 2002;12:65–71.CrossRefGoogle Scholar
  6. 6.
    Sjostrom L, Lindroos AK, Peltonen M, et al. Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. N Engl J Med. 2004;351:2683–93.CrossRefGoogle Scholar
  7. 7.
    Clegg A, Colquitt J, Sidhu M, et al. Clinical and cost effectiveness of surgery for morbid obesity: a systematic review and economic evaluation. Int J Obes Relat Metab Disord. 2003;27:1167–77.CrossRefGoogle Scholar
  8. 8.
    Adams TD, Gress RE, Smith SC, et al. Long-term mortality after gastric bypass surgery. N Engl J Med. 2007;357:753–61.CrossRefGoogle Scholar
  9. 9.
    Sjostrom L, Narbro K, Sjostrom CD, et al. Effects of bariatric surgery on mortality in Swedish obese subjects. N Engl J Med. 2007;357:741–52.CrossRefGoogle Scholar
  10. 10.
    Peeters A, O’Brien PE, Laurie C, et al. Substantial intentional weight loss and mortality in the severely obese. Ann Surg. 2007;246:1028–33.CrossRefGoogle Scholar
  11. 11.
    Busetto L, Mirabelli D, Petroni ML, et al. Comparative long-term mortality after laparoscopic adjustable gastric banding versus nonsurgical controls. Surg Obes Relat Dis. 2007;3:496–502, discussion.CrossRefGoogle Scholar
  12. 12.
    Fried M, Hainer V, Basdevant A, et al. Inter-disciplinary European guidelines on surgery of severe obesity. Int J Obes (Lond). 2007;31:569–77.CrossRefGoogle Scholar
  13. 13.
    Wadden TA, Sarwer DB, Fabricatore AN, et al. Psychosocial and behavioral status of patients undergoing bariatric surgery: what to expect before and after surgery. Med Clin North Am. 2007;91:451–69, xi–xii.CrossRefGoogle Scholar
  14. 14.
    Colles SL, Dixon JB, O’Brien PE. Loss of control is central to psychological disturbance associated with binge eating disorder. Obesity (Silver Spring). 2008;16:608–14.CrossRefGoogle Scholar
  15. 15.
    Lilford RJ. Ethics of clinical trials from a Bayesian and decision analytic perspective: whose equipoise is it anyway? Bmj 2003;326:980–1.CrossRefGoogle Scholar
  16. 16.
    O’Brien PE, Dixon JB, Laurie C, et al. Treatment of mild to moderate obesity with laparoscopic adjustable gastric banding or an intensive medical program: a randomized trial. Ann Intern Med. 2006;144:625–33.CrossRefGoogle Scholar
  17. 17.
    Dixon JB, O’Brien PE, Playfair J, et al. Adjustable gastric banding and conventional therapy for type 2 diabetes: a randomized controlled trial. Jama 2008;299:316–23.PubMedGoogle Scholar

Copyright information

© Springer Science + Business Media, LLC 2008

Authors and Affiliations

  1. 1.Head Obesity Research Unit, School of Primary Health CareMonash UniversityNotting HillAustralia
  2. 2.Baker-IDI Heart and Diabetes InstituteMelbourneAustralia

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