The EAES Clinical Practice Guidelines on Obesity Surgery (2005)

Obesity is an increasingly serious health problem in nearly all Western countries [76, 108, 320]. Although various preventive and conservative treatment options are available, it has been estimated that obesity-related illnesses, such as diabetes mellitus, knee osteoarthritis, systemic hypertension and heart failure, are responsible for an estimated 36% of total health care costs [6, 230, 279]. A recent study on the association between different grades of obesity and the number of life-years lost indicated that life expectancy can be up to 20 years shorter in severe obesity [104]. The consequences of obesity are by far more severe than those of smoking or alcohol [319]. Definition and classification of obesity is based primarily on the body mass index (BMI), calculated as weight divided by the square of height with kilograms per square meter as the unit of measurement [17]. For Caucasians, a BMI of 3035 is considered as class 1 obesity, 3540 as class 2, and over 40 as class 3. Morbid obesity is usually defined as a BMI of over 40 or a BMI over 35 in combination with comorbidities [238]. In addition, some surgeons speak of super- and mega-obesity, if a patients BMI exceeds 50 or 70, respectively. Alternatively, absolute or relative increases in body weight may be used to define obesity. Given the enormous importance of morbid obesity and the limited efficacy of dietetic and pharmacological treatments, surgical treatment has become increasingly popular. The number of procedures performed has more than doubled within a few years [64, 78, 289]. This dramatic growth can be attributed in part also to the introduction of new surgical techniques, e.g. the adjustable silicone gastric band (AGB), and the rise of laparoscopic surgery. Traditionally, there are two types of operations for morbid obesity: Gastric restrictive operations (where food intake is restricted) and malabsorptive operations (where aliments are diverted from absorption via a gastrointestinal shortcut). Both types of obesity surgery are now being performed laparoscopically [38]. The aim of these guidelines is to systematically review the clinical effectiveness of the various surgical procedures and to support surgeons and other physicians in the provision of high-quality care for morbidly obese patients. © Springer Berlin Heidelberg 2006.