Selection of patients for anti-obesity surgery

Obesity is a disease with many comorbidities, some of which increase periop erative risk and most of which are improved or even cured by weight loss ef fectively achieved by surgery. Since anti-obesity surgery is 'behavioral su rgery', outcome is independent of the technical performance of the operatio n and patient selection is critical. Pre- and postoperative patient educati on is more important than in other gastrointestinal surgery. For example, k nowledge of the 'Rules of eating' and the 'Rules of vomiting' are essential for outcome of gastric restrictive surgery. Indications for bariatric surgery are evolving as safety is increasing and more long-term data unequivocally demonstrate its effectiveness, leading to adjustments downward in body mass index and minimum age. However, outcome predictors are lacking, though it is recognized that patient knowledge, psy chosocial adaptation and motivational factors including secondary gain and other benefits to remaining obese are important. Discrepancies between pati ents' weight goals,'ideal' or healthy weight for post-obese individuals and realistic weight loss based on body composition and energy balance, contri bute to subjective assessment of quality of life after bariatric surgery. W ell-designed observational studies rather than randomized trials, which are both ethically and scientifically flawed, are needed to improve patient se lection. Until valid outcome predictors have been identified, a staged appr oach to bariatric surgery entailing long-term reoperation rates of up to 30 % will prevail.