Obesity: Surgical and Device Interventions.

: Bariatric surgery remains the most effective intervention for long-term sustained weight loss and resolution of comorbidities. It should be considered for patients with a body mass index of 40 kg/m2 or greater regardless of comorbidities and for patients with a body mass index of 30 kg/m2 with significant comorbidities, such as diabetes and sleep apnea. For these patients, laparoscopic bariatric surgery, including sleeve gastrectomy, Roux-en-Y gastric bypass, and duodenal switch, is safe with minimal perioperative risks of morbidity and mortality. Surgical management is associated with a survival benefit and resolution of common morbidities compared with nonsurgical management, despite the risk of postsurgical complications. These include gastroesophageal reflux disease, weight regain, bleeding, infection, and deep venous thrombosis. All patients who have undergone bariatric surgery require lifelong follow-up, including vitamin supplementation, annual laboratory testing, and multidisciplinary care (eg, dietary and psychological support). Bariatric surgery also has been shown to be safe in appropriate adolescent and elderly patients.