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Cme ACTIvITY A Brief Review of Bariatric Surgery in the US AT AN eSTImATeD COST of $147 billion to the United States in 2008, obesity currently affects more than 35 percent of American adults. Prevalence varies widely among different socioeconomic conditions, and, as a result, the root causes of obesity continue to be hotly debated, while the list of associated medical complications continues to grow.1 Whether one subscribes to the "nature" or the "nurture" school of thought, bariatric surgery has been tested and repeatedly found to be the most successful treatment option for addressing obesity as well as common comorbidities. A controlled Swedish study involving 4,047 patients with obesity found that 14 years after bariatric surgery, patients experienced a significantly reduced number of cardiovascular deaths (P = .002) and lower incidence of cardiovascular events (P < .001) compared with those who had undergone nonsurgical treatments.2 Another study confirmed a highly reduced rate of metabolic disorders, diabetes and cardiovascular events among bariatric surgery patients compared to patients who did not receive the surgery.3 Though commonly associated with combating obesity, bariatric surgery has historically served other purposes, such as the treatment of liver steatosis and ferritin concentrations.4 Despite positive patient outcomes relating to long-term weight loss and management of other diseases heavily associated with obesity, some studies have suggested that postoperative patients may be prone to other complications including increased risk of fracture,5 potential pharmacokinetic absorption effects and negative effects on future pregnancies.6 Currently, the generally accepted criteria for surgical treatment includes a BMI of greater than 40 kg/m2, or a BMI of greater than 35 kg/m2 with a co-morbidity. Contraindications to bariatric surgery include illnesses that greatly reduce life expectancy and are unlikely to be improved with weight reduction, as well as patients who are unable to understand the nature of the surgery or the required postoperative behavioral changes. To learn more about the various t ypes of bariatric surger y and receive CME credit please visit cme.dannemiller.com/mdnews/dec. Dannemiller Inc. has been a leader in continuing medical education for 30 years. Known for its annual anesthesiology and pain management review courses, the company continues to expand its offering to a wide range of specialties in the medical community. The company's educational offerings encompass a multitude of delivery modalities, some of which include: board certification review courses; live lectures and handson demonstrations; and online articles, abstracts, monographs and webinars. ■ references 1. Overweight and Obesity. (2013, August 16). Retrieved 2013, October 28 from the Centers for Disease Control and Prevention: http://www.cdc.gov/obesity/data/adult.html 2. Sjöström L, et al. (2012, January 4) Bariatric surgery and long-term cardiovascular events. JAMA;307(1):56-65. 3. BMJ 2013; 347:f5934 4. Pontiroli, A. E., et al. (2013). Other aspects of bariatric surgery; liver steatosis, ferritin and cholesterol metabolism. NUTRICION HOSPITALARIA, 28, 104-108. 5. Nakamura, K. M., et al. (2013). Fracture risk following bariatric surgery: a population-based study. Osteoporosis International, 1-8 6. Kjær, M. M., et al. (2013). The risk of adverse pregnancy outcome after bariatric surgery-a nationwide register-based matched cohort study. American Journal of Obstetrics and Gynecology. mDNewS.COm ■ MD News San Antonio | 11