Best Practice & Research Clinical Gastroenterology 28 (2014) 531e532
Contents lists available at ScienceDirect
Best Practice & Research Clinical Gastroenterology
Preface
Obesity and the gastrointestinal tract
Obesity (Body Mass index 30 kg/m2) is a chronic, lifelong, multi-factorial and genetically related, life-threatening disease of excessive fat storage, which in addition to how the fat is distributed, places the individual at risk of premature death and obesity-associated co-morbidities. Hereditary, biochemical, neuroendocrine, hormonal, environmental, psychological, behavioural and cultural elements are involved. Obesity is rarely the result of an aberrant moral problem or addictive behaviour. The consequences of obesity, and morbid obesity (BMI >40 kg/m2 or >35 kg/m2 with obesity related co-morbidity) in particular, are not only premature death and disability from obesity, directly and through the associated co-morbidities, resulting in an increased health care financial burden but also poor psychosocial functioning, impaired quality of life, prejudice, social stigmatization and discrimination, and loss of productivity. 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 gastrointestinal tract, liver and pancreas are involved as well. In the second place, the gastrointestinal tract is involved in the regulation of the energy balance and many treatments are concentrated on the digestive tract. Moreover, in search of less invasive interventions for obesity and morbid obesity more and more endoscopic techniques are developed. The third reason is the burgeoning interest in bariatric surgery. Annually more than 350,000 patients are treated worldwide. The gastroenterologist is an indispensable link in solving postoperative problems and complications. All these aspects are discussed in detail in the present edition of Best Practice & Research Clinical Gastroenterology with very recent insights into the pathophysiology and its consequences for treatment. The reader will become fascinated by the complex regulation of metabolism by food ingredients, microbiota, bile acids, cytokines and adipokines and by the underlying mechanisms of a disease that overwhelms both developed and developing countries. Prevention is the key, but that is no concern of the already obese subject. Treatment by intensive lifestyle changes by diet, exercise and behaviour changes is the first step but difficult to carry on in an obese environment. If intensive lifestyle changes have failed, the next steps are pharmacotherapy, endoscopic bariatric therapy and finally bariatric surgery. The past, present and future and the mode of action are discussed extensively. This issue, entitled Obesity and the Gastrointestinal Tract, should guide the gastroenterologist in the decision to actively participate in the treatment of the obese subject by evaluating symptoms, diagnosing and treating obesity-related diseases, and offering help in weight loss and weight loss failure. Obesity is a global epidemic and, at the global level, the future remains bright for the gastroenterologist! E.M.H. Mathus-Vliegen, MD, PhD, Gastroenterologist, Professor in Clinical Nutrition* Department of Gastroenterology & Hepatology, Academic Medical Centre University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
http://dx.doi.org/10.1016/j.bpg.2014.07.014 1521-6918/© 2014 Elsevier Ltd. All rights reserved.
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Preface / Best Practice & Research Clinical Gastroenterology 28 (2014) 531e532
J.W.M. Greve, MD, PhD, Medical Director Dutch Obesity Clinic South, Chair Department of Bariatric and Metabolic Surgery Atrium Medical Centre, Henry Dunantstraat 5, 6419 CX Heerlen, The Netherlands Orbis Medical Centre, Sittard, The Netherlands Corresponding author. E-mail address: [email protected] (E.M.H. Mathus-Vliegen)
Contents lists available at ScienceDirect
Best Practice & Research Clinical Gastroenterology
Preface
Obesity and the gastrointestinal tract
Obesity (Body Mass index 30 kg/m2) is a chronic, lifelong, multi-factorial and genetically related, life-threatening disease of excessive fat storage, which in addition to how the fat is distributed, places the individual at risk of premature death and obesity-associated co-morbidities. Hereditary, biochemical, neuroendocrine, hormonal, environmental, psychological, behavioural and cultural elements are involved. Obesity is rarely the result of an aberrant moral problem or addictive behaviour. The consequences of obesity, and morbid obesity (BMI >40 kg/m2 or >35 kg/m2 with obesity related co-morbidity) in particular, are not only premature death and disability from obesity, directly and through the associated co-morbidities, resulting in an increased health care financial burden but also poor psychosocial functioning, impaired quality of life, prejudice, social stigmatization and discrimination, and loss of productivity. 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 gastrointestinal tract, liver and pancreas are involved as well. In the second place, the gastrointestinal tract is involved in the regulation of the energy balance and many treatments are concentrated on the digestive tract. Moreover, in search of less invasive interventions for obesity and morbid obesity more and more endoscopic techniques are developed. The third reason is the burgeoning interest in bariatric surgery. Annually more than 350,000 patients are treated worldwide. The gastroenterologist is an indispensable link in solving postoperative problems and complications. All these aspects are discussed in detail in the present edition of Best Practice & Research Clinical Gastroenterology with very recent insights into the pathophysiology and its consequences for treatment. The reader will become fascinated by the complex regulation of metabolism by food ingredients, microbiota, bile acids, cytokines and adipokines and by the underlying mechanisms of a disease that overwhelms both developed and developing countries. Prevention is the key, but that is no concern of the already obese subject. Treatment by intensive lifestyle changes by diet, exercise and behaviour changes is the first step but difficult to carry on in an obese environment. If intensive lifestyle changes have failed, the next steps are pharmacotherapy, endoscopic bariatric therapy and finally bariatric surgery. The past, present and future and the mode of action are discussed extensively. This issue, entitled Obesity and the Gastrointestinal Tract, should guide the gastroenterologist in the decision to actively participate in the treatment of the obese subject by evaluating symptoms, diagnosing and treating obesity-related diseases, and offering help in weight loss and weight loss failure. Obesity is a global epidemic and, at the global level, the future remains bright for the gastroenterologist! E.M.H. Mathus-Vliegen, MD, PhD, Gastroenterologist, Professor in Clinical Nutrition* Department of Gastroenterology & Hepatology, Academic Medical Centre University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
http://dx.doi.org/10.1016/j.bpg.2014.07.014 1521-6918/© 2014 Elsevier Ltd. All rights reserved.
532
Preface / Best Practice & Research Clinical Gastroenterology 28 (2014) 531e532
J.W.M. Greve, MD, PhD, Medical Director Dutch Obesity Clinic South, Chair Department of Bariatric and Metabolic Surgery Atrium Medical Centre, Henry Dunantstraat 5, 6419 CX Heerlen, The Netherlands Orbis Medical Centre, Sittard, The Netherlands Corresponding author. E-mail address: [email protected] (E.M.H. Mathus-Vliegen)
