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Volume 123, Issue 3 , Pages 882-932, September 2002

AGA technical review on obesity☆☆☆★★★♢

Abstract

Obesity is a chronic and stigmatizing disease that has become a major health problem in most industrialized countries because of its high prevalence, causal relationship with serious medical illnesses, and economic impact. In the United States, it is estimated that obesity is responsible for approximately 300,000 deaths per year,¹ and that the direct (medical expenses) and indirect (value of lost productivity) costs of obesity exceed $100 billion per year.² Obesity has particular relevance for gastroenterologists because (1) obesity causes gastrointestinal diseases, including cholelithiasis, pancreatitis, and liver disease; (2) patients who have had obesity surgery may need a gastroenterologist to evaluate and treat postoperative intestinal complications; and (3) the gastrointestinal tract is a viable target for current and future obesity therapies that affect nutrient absorption or gut hormones involved in appetite regulation.

GASTROENTEROLOGY 2002;123:882-932

Abbreviations: BDD , balanced-deficit diet, BMI , body mass index, CHD , coronary heart disease, FFM , fat-free mass, GBP , gastric bypass procedure, GERD , gastroesophageal reflux disease, HDL , high-density lipoprotein, IIH , idiopathic intracranial hypertension, JIB , jejunoileal bypass, LASGB , laparoscopically inserted adjustable silicone gastric band, LCDs , low-calorie diets, LDL , low-density lipoprotein, LES , lower esophageal sphincter, NASH , nonalcoholic steatohepatitis, NAFLD , nonalcoholic fatty liver disease, NHLBI , National Heart, Lung and Blood Institute, PAI-1 , plasminogen activator inhibitor 1, REE , resting energy expenditure, SF-36 , Study Short-Form Health Survey, SOS , Swedish Obese Subjects, TEE , total energy expenditure, TOHP II , Trials of Hypertension Prevention Phase II, UGI , upper gastrointestinal radiographic, USFDA , United States Food and Drug Administration, VBG , vertical-banded gastroplasty, VLCDs , very-low-calorie diets

☆ Address requests for reprints to: Chair, Clinical Practice Committee, AGA National Office, c/o Membership Department, 7910 Woodmont Avenue, 7^th Floor, Bethesda, Maryland 20814. fax: (301) 654-5920.

☆☆ Supported by National Institutes of Health grants DK 37948, DK 56341, DK12614, and RR-00036.

★ This literature review and the recommendations therein were prepared for the American Gastroenterological Association Clinical Practice Committee. The paper was approved by the Committee on March 3, 2002, and by the AGA Governing Board on May 19, 2002.

★★ Dr. Klein has received honoraria for speaking engagements on obesity from Roche Laboratories and R. W. Johnson; is a member of the Obesity and Diabetes Educational Council, which is funded by an unrestricted educational grant provided by Roche Laboratories; and has received research support for clinical studies from Roche Laboratories, R.W. Johnson, DMV International, Regeneron Pharmaceuticals, Novartis Nutrition, and GlaxoSmithKline. These funds were used for participating in multicenter clinical research trials and for investigator-initiated research in obesity.

♢ Dr. Wadden serves on the speakers' bureau for Abbott Laboratories and Roche Laboratories, which manufacture the weight-loss medications sibutramine and orlistat, respectively. He has received research support from Schering-Plough, GlaxoSmithKline, and Abbott Laboratories.

PII: S0016-5085(02)00180-4