Obesity is becoming increasingly prevalent. One-third of the population is obese (Body Mass Index of 30 or greater). An additional one-third of the population is overweight (Body Mass Index of 25-29.9). The prevalence of obesity is even higher among some minority populations; over 50% of African American females are obese. Obesity increases the risk of hypertension, diabetes, and coronary artery disease.
Surgery for obesity (bariatric surgery) is increasing. I am involved in the bariatric surgery program at the University of Mississippi Medical Center. I screen these patients for sleep apnea (breathing pauses during sleep) prior to their surgery. Usually the surgeries go ok, but there are occasional complications. Nationally, the mortality rate is estimated at 1/50 to 1/1000. As a psychiatric consultant, I have seen several of these patients for depression after they have been in the hospital for months with complications, including fistulas and wound problems. One lady was hospitalized a total of 8 months within a 9 month period.
Medicare now covers bariatric surgery for most of the elderly, though work is underway to standardize the elgibility criteria: http://www.ama-assn.org/amednews/2004/12/06/gvsc1206.htm. We need outcome data in the elderly. Most of the surgical experience so far has been with younger patients. In younger patients, bariatric surgery improves survival in the long-term at the expense of increased mortality in the first several months post-operatively. The risk/benefit ratio in the elderly is uncertain. We also need more standardization of the pre-operative work-up for bariatric surgery in all age groups: