Experts Discuss Developments in Bariatric Surgery

In May 2002, the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) brought together nationally recognized experts in obesity and bariatric surgery to address current issues in the field. Dr. Griffin Rodgers, Deputy Director of NIDDK, called the meeting a state-of-the-art review of “what we know, what we think we know, and what we can ask about bariatric surgery as it relates to obesity.”

Researchers know that the 30 percent of adults in the U.S. who are obese (BMI�) have an increased risk of death compared to the normal-weight population, a risk that is greatest among those with extreme obesity (BMI �). Bariatric surgery, which reduces the size of the stomach and may or may not bypass portions of the small intestine to decrease calorie absorption, is currently considered the most effective treatment for extreme obesity. The surgery induces large weight losses that are often sustained for many years.

Bariatric surgical procedures also carry risks, however, and patients require careful long-term follow up to minimize the risks of complications. Workshop participants agreed that further study could help researchers pinpoint the risks and benefits of various surgical procedures, select appropriate patients, and explore the mechanisms by which bariatric surgery induces weight loss and improves related conditions such as diabetes. Enhanced understanding of extreme obesity and its complications could also lead to more effective treatment.

Research could be conducted through a Bariatric Surgery Clinical Research Consortium, in which selected centers performing a large number of bariatric surgical procedures would conduct coordinated clinical research. Such a consortium could ultimately provide evidence-based recommendations for patient evaluation, selection, and follow-up care. It would also permit collaborative studies in more basic areas, such as energy balance, nutrient absorption, physiology and metabolism, and the genetics of severe obesity.

Meeting participants further agreed that establishing a database to track bariatric surgery patients would be extremely valuable to the study of obesity. A database would include information on patients pre- and post-surgery, as well as on patients who do not undergo surgery. As one expert noted, it would assist in answering who should have surgery and why.

The meeting participants generated a host of ideas for continuing research in the area of obesity and bariatric surgery, from which NIDDK staff will identify appropriate initiatives. s