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INTRODUCTION

The surgical treatment of obesity originated with the concept that a surgical intervention to alter digestive anatomy and physiology could benefit patients with a metabolic related disease. At the University of Minnesota in the 1950s, surgeons performed an operation to bypass the distal small bowel to limit absorption of lipids in a patient with severe hyperlipidemia.1 Over 60 years later, the field of metabolic and bariatric surgery has evolved to provide increasingly safe and effective surgical treatment options for patients who suffer the consequences of severe metabolic disease, such as type 2 diabetes mellitus. As these treatments have evolved, there has been a concurrent improved understanding of the physiology underlying the diseases being targeted. This has often been a result of the observations of treatment effects of surgical procedures. Increased insight and knowledge have also arisen as a result of trying to better understand how these interventions can be optimally used for disease treatment. The comorbid metabolic diseases that arise secondary to morbid obesity are generally much better understood than the actual disease of obesity itself. Consequently, surgical treatment has to date focused more on the improvements and resolution of those diseases rather than the disease of obesity. The major manifestation of the disease of obesity, weight itself, certainly has been the focus of bariatric surgery. However, the underlying genetic, physiologic, and metabolic factors that contribute to create the obesity disease state are still not well understood. Hence, surgical therapy has focused on weight as the parameter for treating the disease, while underlying causes are still not directly targeted. Indeed, as investigation continues as to the etiologies of the disease of obesity, surgical therapy may have a more limited role in the future. However, at this time it remains the single most effective treatment for reversing the disease, both in terms of the obvious problem of weight itself as well as the comorbid medical problems that accompany the disease in varying frequency from individual to individual.

The metamorphosis of the surgical patient who has had a successful bariatric operation and has changed from an individual literally burdened by diseases of—and related to—obesity is a dramatic and rewarding phenomenon. Metamorphosis is a truly accurate word to describe this therapeutic change. The massive improvement in quality of life, in physical, mental, and social areas, causes most patients who experience this process to be almost reborn in the true sense of the word. They are relieved of physical pain, social stigmatism, lifestyle limitations, low self-esteem, and a variety of other negative consequences of the obesity state with its concurrent problems. Often the simple fear of imminent death from obesity-related diseases, and the relief that treatment has allowed them to have a chance to live longer is a powerful aspect of treatment success.

The metamorphosis of the surgical patient who has undergone an operative procedure with successful weight loss and resolution or improvement of comorbid medical problems is joyful ...

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