Bariatric surgery: a history of empiricism, a future in science.
BACKGROUND
The observation that obesity can be successfully treated by gastrointestinal surgery is a tribute to the innovative efforts by determined surgeons and the ever improving safety of general anesthesia. Yet as the body of knowledge and discovery on the root causes of human obesity accumulate, surgical approaches to treat morbid obesity are likely to change dramatically. While there is little doubt that dramatic weight loss can be achieved by surgically creating volume and absorption limitation to the reservoir and digestive functions of the gastrointestinal tract, human progress to more processed foods, less physical activity, and the pervasive public opinion that obesity is self-imposed are major obstacles to more widespread application of this approach.


CONCLUSIONS
Here we provide a mechanico-physiologic analysis of current operations, their rationale and limitations, as well as a glimpse of how future interventions might develop as a result of current knowledge in the field. The future of bariatric surgery is discussed in the context of these emerging technologies and in the context of the politics of obesity.
Alverdy
John C
JC
Department of Surgery and Medicine, University of Chicago, 5841 S. Maryland MC 6090, Chicago, IL, USA. jalverdy@surgery.bsd.uchicago.edu
Prachand
Vivek
V
Flanagan
Brody
B
Thistlethwaite
William A
WA
Siegler
Mark
M
Garfinkel
Marc
M
Angelos
Peter
P
Agarwal
Shailesh
S
Santry
Heena
H
D050110:Bariatric Surgery / Q000009:adverse effects / Q000379:methods / Q000639:trends; D015992:Body Mass Index; D006801:Humans; D010535:Laparoscopy; D009767:Obesity, Morbid / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D016896:Treatment Outcome; D015431:Weight Loss