The Obesity Epidemic: Is Bariatric Surgery the Antidote?

1Department of Surgery, Division of General Surgery; 2Department of Medicine, Division of Gastroenterology, University of Calgary, Calgary, Alberta Correspondence: Dr Eldon Shaffer, University of Calgary, Division of Gastroenterology, Health Science Centre, 3330 Hospital Drive Northwest, Calgary, Alberta T2N 4N1. Telephone 403-210-9363, fax 403-210-9358, e-mail shaffer@ucalgary.ca Received for publication January 2, 2005. Accepted February 23, 2005 EPIDEMIOLOGY AND IMPACT OF OBESITY We live in a supersized world, where big is small, huge is medium and enormous is large. A recent addition to this environment was the Hardee’s “Monster thickburger” boasting a gargantuan 1420 calories and 107 g of fat. Not only has this product taken off, customers have been literally devouring it, leading to a 20% increase in sales at Hardee’s stores since its 2003 debut (1). Therefore, it is not surprising that in the United States, at least 131 million adults are overweight or obese, and obesity is the second most common cause of death in the United States (2). In Canada, the situation is similar, with almost 31% of Canadian adults classified as obese (3); indeed, obesity has doubled over a 13-year period from 1985 to 1998 (4). The health consequences of obesity are devastating and expensive, accounting for 2.4% of the total Canadian health care expenditures for all diseases and a direct cost of $1.8 billion in 1998 (4). Furthermore, obesity is associated with many comorbid illnesses such as hypertension, hypertriglyceridemia, hyperlipidemia, hyperinsulinemia, coronary artery disease, stroke, osteoarthritis, sleep apnea, gastroesophageal reflux disease, pancreatitis and steatohepatitis, as well as breast, endometrial, prostate and colon cancer. These alone account for an additional 2.5 million deaths per year worldwide (5). Thus, organizations such as the National Institutes of Health and the Surgeon General of the United States have acknowledged the importance of the problem and have urged the development of public health strategies to curb the epidemic (6).