Obesity is a complex condition, one with serious social and psychological
dimensions, that affects virtually all age and socioeconomic groups. It is a consequence
of abundance, convenience and underlying biology. Preventing obesity requires
changes in the environment and organisational behaviour, as well as changes in groups,
family and individual behaviour. Treatment strategies vary in different centres and
treatment sectors. Non-surgical management consists of diet, exercise, psychology and
pharmacology. Non-surgical management can achieve weight loss. Anti-obesity drugs
may be effective as adjunctive therapy to diet and physical activity in those subjects
who struggle to lose weight despite following an appropriate weight loss programme.
The problem with non-surgical treatment is of long-term sustainability. Bariatric
surgery is the only management, which has long-term sustainability of weight loss and
reversal of comorbidities. However, it is not applicable to all obese patients. Both
restrictive and malabsorptive procedures have a relatively high success rate in weight
loss and improvement of blood sugar control. However, these procedures have many
pitfalls and complications. Experienced bariatric surgeons in high-volume centres have
achieved minimal morbidity and mortality after weight loss surgery. Patient selection
and preparation is key to success. Special anaesthetic considerations and modifications
must be adhered to. The choice of procedure for any individual patient is a complex
process and depends on many factors. Follow-up after bariatric surgery must be
rigorous to monitor and correct micronutrient deficiency and provide psychological
support to patients who have had to change their life style albeit to a healthier
existence.
Keywords: Audit of outcomes, Bariatric surgery, Complications, Diabetes, Diet,
Exercise, Medical management, Obesity, Psychology, Re-do bariatric surgery.
