Bariatric plastic surgery.

A s aesthetic surgeons, we have an interest not only in the appearance of our patients but also in their general health. Obesity undeniably has a great impact on both. As radical but effective procedures to treat obesity become more common, as is happening now, our surgical expertise in treating the after-effects of massive weight loss will be in greater demand. This is likely to foster the development of what might be dubbed the " new " field of bariatric plastic surgery. The twin epidemics of obesity and diabetes continue to spread unchecked in the United States. The facts about obesity are alarming and their implications profound. A study by the Centers for Disease Control and Prevention, published in the Journal of the American Medical Association, 1 reported that in 1991, 21% of the population — more than 44 million people — were obese (body-mass index > 30), 60% were overweight or obese, and 6 million were morbidly obese. Eight percent of the population — 16.7 million people — had diagnosed diabetes. This trend is likely to continue unabated, given the 95% failure rate among dieters and the alarming increase in teenage obesity. The price exacted by this epidemic is staggering. Obesity is the second leading cause of preventable death in the United States, causing more than 300,000 deaths annually. 2 It is more detrimental to the quality of life and medical well-being than alcohol abuse, drug addiction, poverty, or smoking. Moreover, obesity imposes heavy economic and social costs on both patients and society as a whole. More than $100 billion is spent on treating obesity or medical conditions caused by obesity (compared with $30 billion spent treating heart disease and cancer). 3 Obese people also tend to work less and therefore contribute less to the Social Security system and to economic productivity. Many will become permanently disabled at an early age. Finally, the adverse social impact of obesity, in a society that prizes fitness, youth, and attractiveness, is incalculable. Given the magnitude of this problem, it is not surprising that advances in the management of obesity have been and continue to be developed. In particular, bariatric surgery is becoming a major tool in the treatment of obesity. It is estimated that 60,000 to 100,000 bariatric surgery procedures will be performed in the United States in 2003 alone, up from 20,000 less than a decade ago. It can be expected …