Obesity has become one of the most important health problems that we face today. Rates of obesity have increased every year. As a result, there has been an explosion in weight related illnesses. We are now in an obesity epidemic.

Obesity is now recognized as a chronic disease. For many years there was a stigma associated with obesity. People thought of it as a character flaw or as a lack of will power and self control. We now know that obesity is much more complicated than that. Various biochemical factors such as leptin, grehlin and melanocortin 4 receptor (MC4R) have been implicated. This is an area of active research.

Obesity seems to be a problem of too much fat rather than too much weight. The fat cells, or adipocytes, secrete substances that lead to such conditions as diabetes, high blood pressure and a host of other problems. The causes of obesity are complex. There is probably not one single cause to explain the problem. Genetics, metabolism, changes in dietary intake, an increasingly sedentary lifestyle among other things have been implicated. This is another area of ongoing research.

Obesity affects people negatively throughout the day and every day. Obesity affects one's health, sense of well being and impacts their ability to carry on day to day functions.

Obesity is now the most common cause of preventable death in the United States. 400,000 people die each year from obesity related causes. This is more than twice the number of breast cancer and colon cancer deaths combined. In addition, millions suffer from a wide variety of illnesses which are caused by obesity. These include diabetes, high blood pressure, heart disease, sleep apnea, certain types of cancer, reflux, joint pain, back pain, depression and infertility just to name a few.

Many people feel isolated as a result of their condition. Patients often feel uncomfortable going out into public for fear of ridicule. They often develop low self-esteem. There are also, unfortunately, prejudices against people who suffer from obesity in school and in the work place. Depression is common.

Finally, many people find that their obesity affects their ability to carry on daily activities. Back pain, joint pain, decreased mobility and fatigue can prevent many people from doing the things they like to do. In addition, there are physical limitations such as getting on an airplanes and going to a movie which become impossible. Some people eventually have difficulty maintaining basic hygiene.

Making good food choices and staying active are important components of a healthy life style. This is true for all people, whether they are obese or not. However, diet and exercise as a primary weight loss tool have been disappointing. Failure rates at two years typically approach 95%. There are no other therapies in medicine where a 95% failure rate would be acceptable.

Many agents have been tried. Only two drugs are currently FDA approved for weight loss.

Sibutramine (Meridia) This is an appetite suppressant which showed modest weight loss. There have been problems, however with increased heart rates and high blood pressure. In Italy, it has been suspended from the market due to a high number of adverse reactions.

Orlistat (Xenical) This drug blocks the absorption of fats. It has also showed modest weight loss. It has been associated with GI side effects such as severe diarrhea and fecal incontinence as well as weight regain. A new over the counter form is available (ALLI) which costs $78.00 a month.

In summary, both of these agents are poorly tolerated, the costs are high and the results are modest at best. While there may be new agents in the future, the current medicines available to not offer a good alternative for most patients.

The two most common procedures performed to help people lose weight are Adjustable Laparoscopic Gastric Banding (lap band) and Roux-en-y gastric bypass. There are other procedures which were done in the past (Vertical banded gastroplasty and jejuna illeal bypass) but these are rarely, if ever, done anymore. There are also a few other procedures such as gastric sleeve resection, gastric pacemaker and bileopancreatic diversion, but these are done much less commonly.

It may sound strange to use surgery as a means to lose weight. Some people think it's too extreme.Others think it's an easy way out.In fact, surgery is the only method to lose weight that has been shown to effectively get weight off and keep it off. More importantly, in recent studies, surgery has been shown to reverse many of the medical conditions caused by obesity and has even been shown to lengthen people's lives.Therefore, no matter how strange it may seem, weight loss surgery can save lives and therefore should be considered in appropriate patients. It is as important as cancer surgery or open heart surgery in saving lives and improving people's quality of life.