History and Physical Examination

Morbid obesity is the harbinger of many other diseases that affect essentially every organ system, including the following:

Cardiovascular (eg, hypertension, atherosclerotic heart and peripheral vascular disease with myocardial infarction and cerebral vascular accidents, peripheral venous insufficiency, thrombophlebitis, pulmonary embolism)
Respiratory (eg, asthma, obstructive sleep apnea, obesity-hypoventilation syndrome)
Metabolic (eg, type 2 diabetes, impaired glucose tolerance, hyperlipidemia)
Musculoskeletal (eg, back strain; disc disease; weightbearing osteoarthritis of the hips, knees, ankles, and feet)
Gastrointestinal (eg, cholelithiasis, gastroesophageal reflux disease, nonalcoholic fatty liver disease [steatosis steatohepatitis], hepatic cirrhosis, hepatic carcinoma, colorectal carcinoma)
Urologic (eg, stress incontinence)
Endocrine and reproductive (eg, polycystic ovary syndrome, increased risk of pregnancy and fetal abnormalities, male hypogonadism)
Cancer of the endometrium, breast, ovary, prostate, and pancreas
Dermatologic (eg, intertriginous dermatitis)
Neurologic (eg, pseudotumor cerebri, carpal tunnel syndrome)
Psychologic (eg, depression, eating disorders, body image disturbance)

Workup

Sjöström L, Peltonen M, Jacobson P, Sjöström CD, Karason K, Wedel H, et al. Bariatric surgery and long-term cardiovascular events. JAMA. 2012 Jan 4. 307 (1):56-65. [QxMD MEDLINE Link].
Romeo S, Maglio C, Burza MA, Pirazzi C, Sjöholm K, Jacobson P, et al. Cardiovascular events after bariatric surgery in obese subjects with type 2 diabetes. Diabetes Care. 2012 Dec. 35 (12):2613-7. [QxMD MEDLINE Link].
Anveden Å, Taube M, Peltonen M, Jacobson P, Andersson-Assarsson JC, Sjöholm K, et al. Long-term incidence of female-specific cancer after bariatric surgery or usual care in the Swedish Obese Subjects Study. Gynecol Oncol. 2017 May. 145 (2):224-229. [QxMD MEDLINE Link].
Lidar Z, Behrbalk E, Regev GJ, Salame K, Keynan O, Schweiger C, et al. Intervertebral disc height changes after weight reduction in morbidly obese patients and its effect on quality of life and radicular and low back pain. Spine (Phila Pa 1976). 2012 Nov 1. 37 (23):1947-52. [QxMD MEDLINE Link].
Keating CL, Dixon JB, Moodie ML, Peeters A, Bulfone L, Maglianno DJ, et al. Cost-effectiveness of surgically induced weight loss for the management of type 2 diabetes: modeled lifetime analysis. Diabetes Care. 2009 Apr. 32 (4):567-74. [QxMD MEDLINE Link].
Keating CL, Dixon JB, Moodie ML, Peeters A, Playfair J, O'Brien PE. Cost-efficacy of surgically induced weight loss for the management of type 2 diabetes: a randomized controlled trial. Diabetes Care. 2009 Apr. 32 (4):580-4. [QxMD MEDLINE Link].
Colquitt JL, Pickett K, Loveman E, Frampton GK. Surgery for weight loss in adults. Cochrane Database Syst Rev. 2014 Aug 8. 8:CD003641. [QxMD MEDLINE Link].
Jakobsen GS, Småstuen MC, Sandbu R, Nordstrand N, Hofsø D, Lindberg M, et al. Association of Bariatric Surgery vs Medical Obesity Treatment With Long-term Medical Complications and Obesity-Related Comorbidities. JAMA. 2018 Jan 16. 319 (3):291-301. [QxMD MEDLINE Link].
Ikramuddin S, Korner J, Lee WJ, Thomas AJ, Connett JE, Bantle JP, et al. Lifestyle Intervention and Medical Management With vs Without Roux-en-Y Gastric Bypass and Control of Hemoglobin A1c, LDL Cholesterol, and Systolic Blood Pressure at 5 Years in the Diabetes Surgery Study. JAMA. 2018 Jan 16. 319 (3):266-278. [QxMD MEDLINE Link].
Eisenberg D, Shikora SA, Aarts E, Aminian A, Angrisani L, Cohen RV, et al. 2022 American Society of Metabolic and Bariatric Surgery (ASMBS) and International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) Indications for Metabolic and Bariatric Surgery. Obes Surg. 2023 Jan. 33 (1):3-14. [QxMD MEDLINE Link]. [Full Text].
[Guideline] Nobili V, Vajro P, Dezsofi A, Fischler B, Hadzic N, Jahnel J, et al. Indications and limitations of bariatric intervention in severely obese children and adolescents with and without nonalcoholic steatohepatitis: ESPGHAN Hepatology Committee Position Statement. J Pediatr Gastroenterol Nutr. 2015 Apr. 60 (4):550-61. [QxMD MEDLINE Link].
[Guideline] Rubino F, Nathan DM, Eckel RH, Schauer PR, Alberti KG, Zimmet PZ, et al. Metabolic Surgery in the Treatment Algorithm for Type 2 Diabetes: A Joint Statement by International Diabetes Organizations. Diabetes Care. 2016 Jun. 39 (6):861-77. [QxMD MEDLINE Link].
MacLean LD, Rhode BM, Nohr CW. Late outcome of isolated gastric bypass. Ann Surg. 2000 Apr. 231 (4):524-8. [QxMD MEDLINE Link].
Wittgrove AC, Clark GW, Tremblay LJ. Laparoscopic Gastric Bypass, Roux-en-Y: Preliminary Report of Five Cases. Obes Surg. 1994 Nov. 4 (4):353-357. [QxMD MEDLINE Link].
Higa KD, Ho T, Boone KB. Laparoscopic Roux-en-Y gastric bypass: technique and 3-year follow-up. J Laparoendosc Adv Surg Tech A. 2001 Dec. 11 (6):377-82. [QxMD MEDLINE Link].
Lee WJ, Lee KT, Ser KH, Chen JC, Tsou JJ, Lee YC. Laparoscopic adjustable gastric banding (LAGB) with gastric plication: short-term results and comparison with LAGB alone and sleeve gastrectomy. Surg Obes Relat Dis. 2015 Jan-Feb. 11 (1):125-30. [QxMD MEDLINE Link].
Regan JP, Inabnet WB, Gagner M, Pomp A. Early experience with two-stage laparoscopic Roux-en-Y gastric bypass as an alternative in the super-super obese patient. Obes Surg. 2003 Dec. 13 (6):861-4. [QxMD MEDLINE Link].
Himpens J, Dapri G, Cadière GB. A prospective randomized study between laparoscopic gastric banding and laparoscopic isolated sleeve gastrectomy: results after 1 and 3 years. Obes Surg. 2006 Nov. 16 (11):1450-6. [QxMD MEDLINE Link].
Lee CM, Cirangle PT, Jossart GH. Vertical gastrectomy for morbid obesity in 216 patients: report of two-year results. Surg Endosc. 2007 Oct. 21 (10):1810-6. [QxMD MEDLINE Link].
Cottam D, Qureshi FG, Mattar SG, Sharma S, Holover S, Bonanomi G, et al. Laparoscopic sleeve gastrectomy as an initial weight-loss procedure for high-risk patients with morbid obesity. Surg Endosc. 2006 Jun. 20 (6):859-63. [QxMD MEDLINE Link].
Hamoui N, Anthone GJ, Kaufman HS, Crookes PF. Sleeve gastrectomy in the high-risk patient. Obes Surg. 2006 Nov. 16 (11):1445-9. [QxMD MEDLINE Link].
Silecchia G, Boru C, Pecchia A, Rizzello M, Casella G, Leonetti F, et al. Effectiveness of laparoscopic sleeve gastrectomy (first stage of biliopancreatic diversion with duodenal switch) on co-morbidities in super-obese high-risk patients. Obes Surg. 2006 Sep. 16 (9):1138-44. [QxMD MEDLINE Link].
Himpens J, Dapri G, Cadière GB. A prospective randomized study between laparoscopic gastric banding and laparoscopic isolated sleeve gastrectomy: results after 1 and 3 years. Obes Surg. 2006 Nov. 16 (11):1450-6. [QxMD MEDLINE Link].
Baltasar A, Serra C, Pérez N, Bou R, Bengochea M, Ferri L. Laparoscopic sleeve gastrectomy: a multi-purpose bariatric operation. Obes Surg. 2005 Sep. 15 (8):1124-8. [QxMD MEDLINE Link].
Roa PE, Kaidar-Person O, Pinto D, Cho M, Szomstein S, Rosenthal RJ. Laparoscopic sleeve gastrectomy as treatment for morbid obesity: technique and short-term outcome. Obes Surg. 2006 Oct. 16 (10):1323-6. [QxMD MEDLINE Link].
Langer FB, Bohdjalian A, Felberbauer FX, Fleischmann E, Reza Hoda MA, Ludvik B, et al. Does gastric dilatation limit the success of sleeve gastrectomy as a sole operation for morbid obesity?. Obes Surg. 2006 Feb. 16 (2):166-71. [QxMD MEDLINE Link].
Melissas J, Koukouraki S, Askoxylakis J, Stathaki M, Daskalakis M, Perisinakis K, et al. Sleeve gastrectomy: a restrictive procedure?. Obes Surg. 2007 Jan. 17 (1):57-62. [QxMD MEDLINE Link].
Almogy G, Crookes PF, Anthone GJ. Longitudinal gastrectomy as a treatment for the high-risk super-obese patient. Obes Surg. 2004 Apr. 14 (4):492-7. [QxMD MEDLINE Link].
Milone L, Strong V, Gagner M. Laparoscopic sleeve gastrectomy is superior to endoscopic intragastric balloon as a first stage procedure for super-obese patients (BMI > or =50). Obes Surg. 2005 May. 15 (5):612-7. [QxMD MEDLINE Link].
Moy J, Pomp A, Dakin G, Parikh M, Gagner M. Laparoscopic sleeve gastrectomy for morbid obesity. Am J Surg. 2008 Nov. 196 (5):e56-9. [QxMD MEDLINE Link].
Saber AA, Elgamal MH, Itawi EA, Rao AJ. Single incision laparoscopic sleeve gastrectomy (SILS): a novel technique. Obes Surg. 2008 Oct. 18 (10):1338-42. [QxMD MEDLINE Link].
Gagner M, Gumbs AA, Milone L, Yung E, Goldenberg L, Pomp A. Laparoscopic sleeve gastrectomy for the super-super-obese (body mass index >60 kg/m(2)). Surg Today. 2008. 38 (5):399-403. [QxMD MEDLINE Link].
Hutter MM, Schirmer BD, Jones DB, Ko CY, Cohen ME, Merkow RP, et al. First report from the American College of Surgeons Bariatric Surgery Center Network: laparoscopic sleeve gastrectomy has morbidity and effectiveness positioned between the band and the bypass. Ann Surg. 2011 Sep. 254 (3):410-20; discussion 420-2. [QxMD MEDLINE Link].
Daskalakis M, Berdan Y, Theodoridou S, Weigand G, Weiner RA. Impact of surgeon experience and buttress material on postoperative complications after laparoscopic sleeve gastrectomy. Surg Endosc. 2011 Jan. 25 (1):88-97. [QxMD MEDLINE Link].
Stamou KM, Menenakos E, Dardamanis D, Arabatzi C, Alevizos L, Albanopoulos K, et al. Prospective comparative study of the efficacy of staple-line reinforcement in laparoscopic sleeve gastrectomy. Surg Endosc. 2011 Nov. 25 (11):3526-30. [QxMD MEDLINE Link].
Gentileschi P, Camperchioli I, D'Ugo S, Benavoli D, Gaspari AL. Staple-line reinforcement during laparoscopic sleeve gastrectomy using three different techniques: a randomized trial. Surg Endosc. 2012 Sep. 26 (9):2623-9. [QxMD MEDLINE Link].
Tucker ME. Laparoscopic sleeve gastrectomy: good operation, with limits. Medscape Medical News. Available at https://www.medscape.com/viewarticle/888284. November 9, 2017; Accessed: February 16, 2021.
Saber AA, El-Ghazaly TH, Elian A. Single-incision transumbilical laparoscopic sleeve gastrectomy. J Laparoendosc Adv Surg Tech A. 2009 Dec. 19 (6):755-8 discussion 759. [QxMD MEDLINE Link].
Saber AA, El-Ghazaly TH. Early experience with single incision transumbilical laparoscopic adjustable gastric banding using the SILS Port. Int J Surg. 2009 Oct. 7 (5):456-9. [QxMD MEDLINE Link].
Saber AA, El-Ghazaly TH. Early experience with single-access transumbilical adjustable laparoscopic gastric banding. Obes Surg. 2009 Oct. 19 (10):1442-6. [QxMD MEDLINE Link].
de Zwaan M, Georgiadou E, Stroh CE, Teufel M, Köhler H, Tengler M, et al. Body image and quality of life in patients with and without body contouring surgery following bariatric surgery: a comparison of pre- and post-surgery groups. Front Psychol. 2014. 5:1310. [QxMD MEDLINE Link].
Plecka Östlund M, Wenger U, Mattsson F, Ebrahim F, Botha A, Lagergren J. Population-based study of the need for cholecystectomy after obesity surgery. Br J Surg. 2012 Jun. 99 (6):864-9. [QxMD MEDLINE Link].
Yu EW, Kim SC, Sturgeon DJ, Lindeman KG, Weissman JS. Fracture Risk After Roux-en-Y Gastric Bypass vs Adjustable Gastric Banding Among Medicare Beneficiaries. JAMA Surg. 2019 Aug 1. 154 (8):746-753. [QxMD MEDLINE Link].
Gupta PK, Franck C, Miller WJ, Gupta H, Forse RA. Development and validation of a bariatric surgery morbidity risk calculator using the prospective, multicenter NSQIP dataset. J Am Coll Surg. 2011 Mar. 212 (3):301-9. [QxMD MEDLINE Link].
Podnos YD, Jimenez JC, Wilson SE, Stevens CM, Nguyen NT. Complications after laparoscopic gastric bypass: a review of 3464 cases. Arch Surg. 2003 Sep. 138 (9):957-61. [QxMD MEDLINE Link].
Ungaro R, Fausel R, Chang HL, Chang S, Chen LA, Nakad A, et al. Bariatric surgery is associated with increased risk of new-onset inflammatory bowel disease: case series and national database study. Aliment Pharmacol Ther. 2018 Apr. 47 (8):1126-1134. [QxMD MEDLINE Link].

Media Gallery

Laparoscopic Roux-en-Y gastric bypass.
Adjustable gastric banding.
Sleeve gastrectomy.
Long Roux-en-Y gastric bypass.
Biliopancreatic diversion with duodenal switch.
Progression of surgical techniques, with open surgery in first image and single-incision transumbilical laparoscopic surgery in third illustration.

of 6

Author

Alan A Saber, MD, MS, FACS, FASMBS Director of Bariatric and Metabolic Surgery, University Hospitals Case Medical Center; Surgical Director, Bariatric Surgery, Metabolic and Nutrition Center, University Hospitals Digestive Health Institute; Associate Professor of Surgery, Case Western Reserve University School of Medicine

Alan A Saber, MD, MS, FACS, FASMBS is a member of the following medical societies: American College of Surgeons, American Society for Gastrointestinal Endoscopy, American Society for Metabolic and Bariatric Surgery

Disclosure: Nothing to disclose.

Coauthor(s)

Tarek H El-Ghazaly, MD Fellow of Minimally Invasive and Bariatric Surgery Research, Michigan State University, Kalamazoo Center for Medical Studies

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

John Geibel, MD, MSc, DSc, AGAF Vice Chair and Professor, Department of Surgery, Section of Gastrointestinal Medicine, Professor, Department of Cellular and Molecular Physiology, Yale University School of Medicine; Director of Surgical Research, Department of Surgery, Yale-New Haven Hospital; American Gastroenterological Association Fellow; Fellow of the Royal Society of Medicine

John Geibel, MD, MSc, DSc, AGAF is a member of the following medical societies: American Gastroenterological Association, American Physiological Society, American Society of Nephrology, Association for Academic Surgery, International Society of Nephrology, New York Academy of Sciences, Society for Surgery of the Alimentary Tract

Disclosure: Nothing to disclose.

Additional Contributors

Brian J Daley, MD, MBA, FACS, FCCP, CNSC Professor and Program Director, Department of Surgery, Chief, Division of Trauma and Critical Care, University of Tennessee Health Science Center College of Medicine

Brian J Daley, MD, MBA, FACS, FCCP, CNSC is a member of the following medical societies: American Association for the Surgery of Trauma, Eastern Association for the Surgery of Trauma, Southern Surgical Association, American College of Chest Physicians, American College of Surgeons, American Medical Association, Association for Academic Surgery, Association for Surgical Education, Shock Society, Society of Critical Care Medicine, Southeastern Surgical Congress, Tennessee Medical Association

Disclosure: Nothing to disclose.

Acknowledgements

We wish to thank Ollie J Jackson III, MD, Department of General Surgery, Michigan State University, Kalamazoo Center for Medical Studies, for previous contributions to this entry.

Bariatric Surgery Clinical Presentation

History and Physical Examination

References

Tables

Contributor Information and Disclosures

What would you like to print?