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Bariatrics is the branch of medicine that deals with the causes, prevention, and treatment of obesity. [1]
The term bariatrics was coined around 1965, [2] from the Greek root bar- ("weight" as in barometer), suffix -iatr ("treatment," as in pediatrics), and suffix -ic ("pertaining to"). The field encompasses dieting, exercise and behavioral therapy approaches to weight loss, as well as pharmacotherapy and surgery. The term is also used in the medical field as somewhat of a euphemism to refer to people of larger sizes without regard to their participation in any treatment specific to weight loss, such as medical supply catalogs featuring larger hospital gowns and hospital beds referred to as "bariatric".
Being overweight or obese are both rising medical problems. [3] [4] There are many detrimental health effects of obesity: [5] [6] Individuals with a BMI (Body Mass Index) exceeding a healthy range have a much greater risk of medical issues. [7] These include heart disease, diabetes mellitus, many types of cancer, asthma, obstructive sleep apnea, and chronic musculoskeletal problems. There is also a focus on the correlation between obesity and mortality. [8]
Overweight and obese people, including children, may find it difficult to lose weight on their own. [9] It is common for dieters to have tried fad diets only to find that they gain weight, or return to their original weight, after ceasing the diet. [10] Some improvement in patient psychological health is noted after bariatric surgery. [11] 51% of bariatric surgery candidates report a history of mental illness, specifically depression, as well as being prescribed at least one psychotropic medication at the time of their surgery candidacy. [12] [13]
Although diet, exercise, behavior therapy and anti-obesity drugs are first-line treatment, [14] medical therapy for severe obesity has limited short-term success and very poor long-term success. [15] Weight loss surgery generally results in greater weight loss than conventional treatment, and leads to improvements in quality of life and obesity related diseases such as hypertension and diabetes mellitus. [16] A meta-analysis of 174772 participants published in The Lancet in 2021 found that bariatric surgery was associated with 59% and 30% reduction in all-cause mortality among obese adults with or without type 2 diabetes respectively. [17] This meta-analysis also found that median life-expectancy was 9.3 years longer for obese adults with diabetes who received bariatric surgery as compared to routine (non-surgical) care, whereas the life expectancy gain was 5.1 years longer for obese adults without diabetes. [17]
The combination of approaches used may be tailored to each patient. [18] Bariatric treatments in youth must be considered with great caution and with other conditions that may not have to be considered in adults.
Techniques used in bariatrics include bioelectrical impedance analysis, a method to measure body fat percentage.
Dieting is the practice of eating food in a regulated way to decrease, maintain, or increase body weight, or to prevent and treat diseases such as diabetes and obesity. As weight loss depends on calorie intake, different kinds of calorie-reduced diets, such as those emphasising particular macronutrients, have been shown to be no more effective than one another. As weight regain is common, diet success is best predicted by long-term adherence. Regardless, the outcome of a diet can vary widely depending on the individual.
Obesity is a medical condition, sometimes considered a disease, in which excess body fat has accumulated to such an extent that it can potentially have negative affects on health. People are classified as obese when their body mass index (BMI)—a person's weight divided by the square of the person's height—is over 30 kg/m2; the range 25–30 kg/m2 is defined as overweight. Some East Asian countries use lower values to calculate obesity. Obesity is a major cause of disability and is correlated with various diseases and conditions, particularly cardiovascular diseases, type 2 diabetes, obstructive sleep apnea, certain types of cancer, and osteoarthritis.
Type 2 diabetes (T2D), formerly known as adult-onset diabetes, is a form of diabetes mellitus that is characterized by high blood sugar, insulin resistance, and relative lack of insulin. Common symptoms include increased thirst, frequent urination, fatigue and unexplained weight loss. Symptoms may also include increased hunger, having a sensation of pins and needles, and sores (wounds) that do not heal. Often symptoms come on slowly. Long-term complications from high blood sugar include heart disease, strokes, diabetic retinopathy which can result in blindness, kidney failure, and poor blood flow in the limbs which may lead to amputations. The sudden onset of hyperosmolar hyperglycemic state may occur; however, ketoacidosis is uncommon.
Weight loss, in the context of medicine, health, or physical fitness, refers to a reduction of the total body mass, by a mean loss of fluid, body fat, or lean mass. Weight loss can either occur unintentionally because of malnourishment or an underlying disease, or from a conscious effort to improve an actual or perceived overweight or obese state. "Unexplained" weight loss that is not caused by reduction in calorific intake or increase in exercise is called cachexia and may be a symptom of a serious medical condition.
Gastric bypass surgery refers to a technique in which the stomach is divided into a small upper pouch and a much larger lower "remnant" pouch and then the small intestine is rearranged to connect to both. Surgeons have developed several different ways to reconnect the intestine, thus leading to several different gastric bypass procedures (GBP). Any GBP leads to a marked reduction in the functional volume of the stomach, accompanied by an altered physiological and physical response to food.
The duodenal switch (DS) procedure, gastric reduction duodenal switch (GRDS), is a weight loss surgery procedure that is composed of a restrictive and a malabsorptive aspect.
Childhood obesity is a condition where excess body fat negatively affects a child's health or well-being. As methods to determine body fat directly are difficult, the diagnosis of obesity is often based on BMI. Due to the rising prevalence of obesity in children and its many adverse health effects it is being recognized as a serious public health concern. The term 'overweight' rather than 'obese' is often used when discussing childhood obesity, as it is less stigmatizing, although the term 'overweight' can also refer to a different BMI category. The prevalence of childhood obesity is known to differ by sex and gender.
A very-low-calorie diet (VLCD), also known as semistarvation diet and crash diet, is a type of diet with very or extremely low daily food energy consumption. VLCDs are defined as a diet of 800 kilocalories (3,300 kJ) per day or less. Modern medically supervised VLCDs use total meal replacements, with regulated formulations in Europe and Canada which contain the recommended daily requirements for vitamins, minerals, trace elements, fatty acids, protein and electrolyte balance. Carbohydrates may be entirely absent, or substituted for a portion of the protein; this choice has important metabolic effects. Medically supervised VLCDs have specific therapeutic applications for rapid weight loss, such as in morbid obesity or before a bariatric surgery, using formulated, nutritionally complete liquid meals containing 800 kilocalories or less per day for a maximum of 12 weeks.
Metabolic dysfunction–associated steatotic liver disease (MASLD) is the name adopted in 2023 for the condition previously known as non-alcoholic fatty liver disease (NAFLD). This is excessive fat build-up in the liver without another clear cause such as alcohol use. There are two types; non-alcoholic fatty liver (NAFL) and non-alcoholic steatohepatitis (NASH), with the latter indicating the presence of further liver inflammation. NAFL is less dangerous than NASH and usually does not progress towards it, but this progression may eventually lead to complications such as cirrhosis, liver cancer, liver failure, or cardiovascular disease.
Bariatric surgery is a medical term for surgical procedures used to manage obesity and obesity-related conditions. Long term weight loss with bariatric surgery may be achieved through alteration of gut hormones, physical reduction of stomach size, reduction of nutrient absorption, or a combination of these. Standard of care procedures include Roux en-Y bypass, sleeve gastrectomy, and biliopancreatic diversion with duodenal switch, from which weight loss is largely achieved by altering gut hormone levels responsible for hunger and satiety, leading to a new hormonal weight set point.
The obesity paradox is the finding in some studies of a lower mortality rate for overweight or obese people within certain subpopulations. The paradox has been observed in people with cardiovascular disease and cancer. Explanations for the paradox range from excess weight being protective to the statistical association being caused by methodological flaws such as confounding, detection bias, reverse causality, or selection bias.
Being overweight or fat is having more body fat than is optimally healthy. Being overweight is especially common where food supplies are plentiful and lifestyles are sedentary.
Obesity is a risk factor for many chronic physical and mental illnesses.
Obesity has been observed throughout human history. Many early depictions of the human form in art and sculpture appear obese. However, it was not until the 20th century that obesity became common — so much so that, in 1997, the World Health Organization (WHO) formally recognized obesity as a global epidemic and estimated that the worldwide prevalence of obesity has nearly tripled since 1975. Obesity is defined as having a body mass index (BMI) greater than or equal to 30 kg/m2, and in June 2013 the American Medical Association classified it as a disease.
Weight management refers to behaviors, techniques, and physiological processes that contribute to a person's ability to attain and maintain a healthy weight. Most weight management techniques encompass long-term lifestyle strategies that promote healthy eating and daily physical activity. Moreover, weight management involves developing meaningful ways to track weight over time and to identify ideal body weights for different individuals.
Management of obesity can include lifestyle changes, medications, or surgery. Although many studies have sought effective interventions, there is currently no evidence-based, well-defined, and efficient intervention to prevent obesity.
Frank B. Hu is a Chinese American nutrition and diabetes researcher. He is Chair of the Department of Nutrition and the Fredrick J. Stare Professor of Nutrition and Epidemiology at the Harvard T.H. Chan School of Public Health, and Professor of Medicine at the Harvard Medical School.
Normal weight obesity is the condition of having normal body weight, but with a high body fat percentage, leading to some of the same health risks as obesity.
Katherine Mayhew Flegal is an American epidemiologist and senior scientist at the Centers for Disease Control and Prevention's National Center for Health Statistics. She is one of the most highly cited scientists in the field of the epidemiology of obesity according to Thomson Reuters and has been called "one of the great epidemiologists" by former FDA Commissioner David A. Kessler.
Obesity is defined as an abnormal accumulation of body fat, usually 20% or more over an individual's ideal body weight. This is often described as a body mass index (BMI) over 30. However, BMI does not account for whether the excess weight is fat or muscle, and is not a measure of body composition. For most people, however, BMI is an indication used worldwide to estimate nutritional status. Obesity is usually the result of consuming more calories than the body needs and not expending that energy by doing exercise. There are genetic causes and hormonal disorders that cause people to gain significant amounts of weight but this is rare. People in the obese category are much more likely to suffer from fertility problems than people of normal healthy weight.
