The Future of Bariatric Surgery.
Scientific evidence is pointing more and more strongly to the fact that serious, or morbid, obesity is not a moral issue. Serious obesity is a consequence of a genetically related, powerful biophysiological drive to consume more calories than are burned. This concept must eventually become incorporated into lay and medical paradigms of obesity. It will result in an increased understanding and sympathy for the suffering of the seriously obese and, as a consequence, stronger support for definitive treatment of serious obesity such as bariatric surgery. Reoperative bariatric surgery principles, currently limited by individual exposure and experience, will develop and evolve. Laparoscopic bariatric surgery may, in time, be developed and prove itself to be of value. Bariatric surgeons should also find it useful to enhance their teams' skills for nutritional, behavioral and psychological management, as well as broaden their operative base into other, related surgical areas such as partial ileal bypass procedures for hyperlipidemia management. As fields mature, organizational maturation is a natural and necessary accompaniment. An International Federation for Bariatric Surgery, or similar entity, will be founded to constructively unite national bariatric surgery and related organizations together. The international bariatric surgery journal, Obesity Surgery, will become more and more accepted as the truly professional and essential vehicle of communication concerning bariatric surgery that it has been since its first issue. Medical management simulating the effects of surgery will be employed successfully; it may arise out of the current genetic work. It may ultimately, in the next 25 years or so, replace the surgical treatment of serious obesity.
Cowan
GS
Department of Surgery, University of Tennessee School of Medicine, Memphis, TN 38163 USA.