198 Obesity Treatment
by expert committees in the US (Institute of Medicine, 1995) and the UK
(Garrow, 1987b) and is recommended for those with a BMI over 40 kg/m^2
(or >35 with complications of obesity) who have not lost weight with dietary
or pharmacological interventions as long as they are made aware of the
possible side effects. Some clinicians have also called for its use with ado-
lescents, arguing that it is best to treat obesity as early as possible to prevent
the onset of obesity-related conditions and the lowering of self-esteem (Inge
et al., 2007). However, in parallel to the problems with dieting, individuals
who have surgery can show complete weight regain or no initial weight loss.
Furthermore, they may lose weight too quickly and become malnourished
and also subjected to the dangers of any operation and the accompanying
problems with anesthetics (Mason, 1987).
Psychological effects of surgery
Obesity surgery, however, does not only affect weight. Some research has also
explored postoperative changes in aspects of the individual’s psychological
Figure 9.5 Vertical stapled gastroplasty. (Source: After J.G. Kral, Surgical
interventions for obesity, in K.D. Brownell and C.G. Fairburn (eds.), Eating
Disorders and Obesity, New York: Guilford Press, 1995, pp. 510–15.)
Image not available in the electronic edition