The duodenal switch as an increasing and highly effective operation for morbid obesity.

“Morbid Obesity” (ICD 278.01 / BMI >40) is an entity distinct from “ o b e s i t y ” , the latter term encompassing the broad ra n ge of ove r we i g h t . Available treatment modalities as well as outcomes differ substantially over the spectrum of higher BMI. Representative data for behavior modification, diet and exercise show at best an average weight loss of 4-7 kg at 2 years, with decreasing benefit in the longer term.1-3 The reported maximum of 7 kg is hardly significant for a morbidly obese individual who might be carrying an excess weight 45-75 kg or more. Those morbidly obese patients who do respond to non-surgical weight loss programs, generally fail to maintain the weight loss, with recidivism rates exceeding 95%.4 Behavior modification, diet and exercise have been found to be ineffective on an intermediate and long-term basis for treatment of obesity, particularly morbid obesity. Regain of the lost weight is the rule, and more than the initial weight lost is commonly regained.5,6 Surgery is the only modality proven to be effective in the treatment of morbid obesity;7 however, surgical treatment entails known finite risks influenced by clinical factors. To achieve a beneficial net reduction in morbidity and mortality, the risks from the excess weight must exceed the risks of surgery and anesthesia. It is interesting to note that published series show significant increases in the relative risk associated with obesity at a BMI of 27 kg/m2, and exponential increases at a BMI of 32 kg/m2 (the highest bracket reported)8,9 – well below the 35 to 40 kg/m2 often considered minimum for surgical intervention.