Severe/extreme obesity: A medical disease requiring a surgical treatment?

Obesity poses a serious health hazard and its treatment is often disappoint ing. Surgical approaches have been proposed for treating severe obesity (bo dy mass index or BMI greater than or equal to 35 kg/m(2)) with comorbiditie s or extreme obesity (BMI greater than or equal to 40 kg/m(2)). Before acce pting bariatric surgery as alternative treatment, the four following prereq uisites should be met: 1) the medical condition is serious enough; 2) it can not be treated satisfactorily with classical means; 3) the surgical treatment is effective in improving the clinical situation; and 4) bariatric surgery is safe enough, so that the benefits clearly outweigh the risks. On the basis of the literature and our own experience, it appears that gast ric reduction surgery may be considered as a valuable alternative for treat ing severe/extreme obesity, despite the possible occurrence of perioperativ e and, more frequently, late complications, provided that it is performed b y an experienced and multidisciplinary team in well-selected patients.