title: Treatment of Obesity: Weight Loss and Bariatric Surgery.
abstract: This review focuses on the mechanisms underlying, and indications for, bariatric surgery in the reduction of cardiovascular disease (CVD), as well as other expected benefits of this intervention. The fundamental basis for bariatric surgery for the purpose of accomplishing weight loss is the determination that severe obesity is a disease associated with multiple adverse effects on health, which can be reversed or improved by successful weight loss in patients who have been unable to sustain weight loss by nonsurgical means. An explanation of possible indications for weight loss surgery as well as specific bariatric surgical procedures is presented, along with review of the safety literature of such procedures. Procedures that are less invasive or those that involve less gastrointestinal rearrangement accomplish considerably less weight loss but have substantially lower perioperative and longer-term risk. The ultimate benefit of weight reduction relates to the reduction of the comorbidities, quality of life, and all-cause mortality. With weight loss being the underlying justification for bariatric surgery in ameliorating CVD risk, current evidence-based research is discussed concerning body fat distribution, dyslipidemia, hypertension, diabetes mellitus, inflammation, obstructive sleep apnea, and others. The rationale for bariatric surgery reducing CVD events is discussed and juxtaposed with impacts on all-cause mortalities. Given the improvement of established obesity-related CVD risk factors after weight loss, it is reasonable to expect a reduction of CVD events and related mortality after weight loss in populations with obesity. The quality of the current evidence is reviewed, and future research opportunities and summaries are stated.
authors.affiliation: From the Department of Surgery, Oregon Health and Science University, Portland (B.M.W., E.K.); and Division of Endocrinology, Metabolism and Diabetes, Department of Medicine, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora (R.H.E.). wolfeb@ohsu.edu.
authors.forename: Bruce M
authors.initials: BM
authors.lastname: Wolfe
authors.affiliation: From the Department of Surgery, Oregon Health and Science University, Portland (B.M.W., E.K.); and Division of Endocrinology, Metabolism and Diabetes, Department of Medicine, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora (R.H.E.).
authors.forename: Elizaveta
authors.initials: E
authors.lastname: Kvach
authors.affiliation: From the Department of Surgery, Oregon Health and Science University, Portland (B.M.W., E.K.); and Division of Endocrinology, Metabolism and Diabetes, Department of Medicine, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora (R.H.E.).
authors.forename: Robert H
authors.initials: RH
authors.lastname: Eckel
mesh_terms: D050110:Bariatric Surgery / Q000009:adverse effects / Q000379:methods*; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D009765:Obesity / Q000150:complications / Q000453:epidemiology / Q000601:surgery*; D015431:Weight Loss
keywords: cardiac metabolism; hypertension; inflammation; obesity; sleep apnea