Biliopancreatic diversion. A 2005 medical guideline by the American College of Physicians concluded: *<unk>  should be considered as a treatment option for patients with a BMI of 40 kg/m2 or greater who instituted but failed an adequate exercise and diet program (with or without adjunctive drug therapy) and who present with obesity-related comorbid conditions, such as hypertension, impaired glucose tolerance, diabetes mellitus, hyperlipidemia, and obstructive sleep apnea. A doctor–patient discussion of surgical options should include the long-term side effects, such as a possible need for reoperation, gallbladder disease, and malabsorption." * "Patients should be referred to high-volume centers with surgeons experienced in<unk> ." The<unk>  is contraindicated in patients who have end stage disease and also in patients not committed to make lifestyle changes considered ideal for the<unk> . In 2011, the International Diabetes Federation had suggested in a position statement "Under some circumstances, people with a BMI 30–35 should be eligible for<unk> ." When determining eligibility for<unk>  for extremely obese patients, psychiatric screening is critical, also for determining postoperative success. Patients with a body-mass index of 40 kg/m2 or greater have a 5-fold risk of depression, and half of<unk>  candidates are depressed. Weight loss In adults In general, the malabsorptive procedures lead to more weight loss than the restrictive procedures; however, they have a higher risk profile. A 2005 meta-analysis from University of California, Los Angeles, reported the following weight loss at 36 months: Biliopancreatic diversion — 117 Lbs / 53 kg, Roux-en-Y gastric bypass (RYGB) — 90 Lbs / 41 kg, Open — 95 Lbs/ 43 kg, Laparoscopic — 84 Lbs / 38 kg, Vertical banded gastroplasty — 71 Lbs / 32 kg. A 2017 meta-analysis reported that it was effective at reducing weight among morbidly obese adults in China. In children and teens As of 2019, the {American Academy of Pediatrics has recommended<unk>  without age-based eligibility limits under the following indications: BMI >35 with severe comorbidity, such as obstructive sleep apnea (Apnea-Hypopnea Index >.5), Type2 Diabetes mellitus, idiopathic intracranial hypertension, nonalcoholic steatohepatitis, Blount disease, slipped capital femoral epiphysis, gastroesophageal reflux disease, and idiopathic hypertension or a BMI >40 kg/m2 without comorbidities.<unk>  is contraindicated with a medically correctable cause of obesity, substance abuse, concurrent or planned pregnancy, eating disorder, or inability to adhere to postoperative recommendations and mandatory lifestyle changes. A 2017 meta-analysis found<unk>  to be effective for weight loss in adolescents 36 months after the intervention and that additional data was needed to determine whether it is also effective for long-term weight loss in adolescents. According to the Canadian Agency for Drugs and Technologies in Health, the comparative evidence base for<unk>  in adolescents and young adults was as of 2016 "...limited to a few studies that were narrow in scope and with relatively small sample sizes." Reduced mortality and morbidity In the short term, weight loss from<unk> es is associated with reductions in some comorbidities of obesity, such as diabetes, metabolic syndrome and sleep apnea, but the benefit for hypertension is uncertain. It is uncertain whether any given<unk>  procedure is more effective than another in controlling comorbidities. There is no high quality evidence concerning longer-term effects compared with conventional treatment on comorbidities.<unk>  has been shown to be linked to longer life expectancy, compared with non-operated control patients with obesity.<unk>  in older patients has also been a topic of debate, centered on concerns for safety in this population; the relative benefits and risks in this population is not known. Given the remarkable rate of diabetes remission with<unk> , there is considerable interest in offering this intervention to people with type 2 diabetes who have a lower BMI than is generally required for<unk> , but high quality evidence is lacking and optimal timing of the procedure is uncertain. Laparoscopic<unk>  requires a hospital stay of only one or two days. Short-term complications from laparoscopic adjustable gastric banding are reported to be lower than laparoscopic Roux-en-Y<unk> , and complications from laparoscopic Roux-en-Y<unk>  are lower than conventional (open) Roux-en-Y<unk> . A meta-analysis of 174772 participants published in The Lancet in 2021 found that<unk>  was associated with 59% and 30% reduction in all-cause mortality among obese adults with or without type 2 diabetes respectively. This meta-analysis also found that median life-expectancy was 9.3 years longer for obese adults with diabetes who received<unk>  as compared to routine (non-surgical) care, whereas the life expectancy gain was 5.1 years longer for obese adults without diabetes. Fertility and pregnancy The position of the American Society for Metabolic and<unk>  as of 2017 was that it was not clearly understood whether medical weight-loss treatments or<unk>  had an effect responsiveness to subsequent treatments for infertility in both men and women.<unk>  reduces the risk of gestational diabetes and hypertensive disorders of pregnancy in women who later become pregnant but increases the risk of preterm birth. Psychiatric and psychological Some studies have suggested that psychological health can improve after<unk> .
Bariatric surgery
Gastric bypass surgery
Bariatrics
Endoscopic sleeve gastroplasty
Rosedale diet
Low-carbohydrate diet
Specific carbohydrate diet
Scarsdale diet