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Endoscopy 2009; 41(7): 608-611
DOI: 10.1055/s-0029-1214889
Editorial

© Georg Thieme Verlag KG Stuttgart · New York

Obesity and the gastroenterologist

E.  M . H.  Mathus-Vliegen1
  • 1Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands
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Publikationsdatum:
08. Juli 2009 (online)

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Obesity (body mass index [BMI] ≥ 30 kg/m2) is a chronic, incurable and life-threatening disease of excess fat storage. The absolute and relative excess of adipose tissue and the visceral distribution of fat place the individual at risk of premature death and obesity-associated co-morbidities. A considerable decrease in life expectancy is associated with obesity. A very recent analysis of 57 prospective studies has assessed the associations of BMI with overall and cause-specific mortality [1]. In both sexes, mortality was lowest at about 22.5 – 25 kg/m2. After adjustment for age, sex, smoking status, and after correction for reverse causality, the median survival at BMI 30 – 35 kg/m2 was reduced by 2 – 4 years and at BMI 40 – 45 kg/m2 by 8 – 10 years. Each 5 kg/m2 higher BMI was associated with about 30 % higher overall mortality: 40 % for vascular mortality, 120 % for diabetic, 60 % for renal and 82 % for hepatic mortality, 10 % for neoplastic mortality, and 20 % for respiratory mortality. In the EPIC study (European Prospective Investigation into Cancer and Nutrition) both general adiposity and abdominal adiposity were associated with significant increased risks of death [2].

There are several reasons why gastroenterologists should take care of the obese patient. In the first place, the health implications are substantial; almost every organ system is affected by obesity and the digestive tract is involved as well. In the second place, the gastrointestinal tract is involved in the regulation of the energy balance and many treatments will concentrate on the digestive tract. The third reason is the burgeoning interest in bariatric surgery. Gastroenterologists should participate in the multidisciplinary treatment group; this implies a thorough knowledge of the surgically altered anatomy with its complications and side-effects which are different for each of the surgical interventions [3]. The gastroenterologist may be an indispensable link in solving postoperative problems and complications. The common indications for a gastroenterological consultation and for an endoscopy include the evaluation of symptoms because many of the complications and side-effects of weight-loss procedures are related to alterations in the gastrointestinal tract, the management of expected and unexpected complications, and the evaluation of failure of weight loss [4] [5].