For decades, conventional wisdom has considered obesity a disease of bad habits and weak will power. There has been tremendous reluctance to treat with either drugs or surgery a disease believed by many to be within the control of those affected. With new information on the ob gene in mice and the beta-3 receptor mutation in humans, it is becoming clear that obesity is a physiologically controlled variable like high blood pressure.<sup>32 Campfield L.A., Smith F.J., Guisez Y. , y al. Recombinant mouse OB protein: Evidence for a peripheral signal linking adiposity and central neural networks Science 1995 ;  269 (5223) : 546-549

Haga clic aquí para ir a la sección de Referencias, 38 Clement K., Vaisse C., Manning B.S. , y al. Genetic variation in the beta 3-adrenergic receptor and an increased capacity to gain weight in patients with morbid obesity N Engl J Med 1995 ;  333 : 352-354  [cross-ref]

Haga clic aquí para ir a la sección de Referencias, 73 Halaas J.L., Gajiwala K.S., Maffei M. , y al. Weight-reducing effects of the plasma protein encoded by the obese gene Science 1995 ;  269 (5223) : 543-546

Haga clic aquí para ir a la sección de Referencias, 130 Pelleymounter M.A., Cullen M.J., Baker M.B. , y al. Effects of the obese gene product on body weight regulation in ob/ob mice Science 1995 ;  269 (5223) : 540-543

Haga clic aquí para ir a la sección de Referencias, 178 Walston J., Silver K., Bogardus C. , y al. Time of onset of non-insulin-dependent diabetes mellitus and genetic variation in the beta 3-adrenergic-receptor gene N Engl J Med 1995 ;  333 : 343-347  [cross-ref]

Haga clic aquí para ir a la sección de Referencias, 185 Widen E., Lehto M., Kanninen T. , y al. Association of a polymorphism in the beta 3-adrenergic-receptor gene with features of the insulin resistance syndrome in Finns N Engl J Med 1995 ;  333 : 348-351  [cross-ref]

Haga clic aquí para ir a la sección de Referencias</sup> With this in mind, it is no surprise that only chronic treatments will provide a lasting solution to the problem of obesity. This explains why short-term behavior modification, diet, exercise, and drugs have been disappointing in their long-term success. Surgery with its inherent permanence clearly has the best long-term success in treating the obese condition.

The history of surgery for the treatment of obesity is long and remarkable. The original attempts to provide surgical treatment occurred in a period of time when it was perceived that bad eating and exercise habits were being treated operatively in patients too weak-willed to follow the safer medical treatments of diet and exercise. Although Kremen and colleagues reported the use of ileal bypass for extreme obesity in one patient in 1954, Payne and co-workers<sup>128 Payne J.H., DeWind L.T., Commons R.R. Metabolic observations in patients with jejunocolic shunts Am J Surg 1963 ;  106 : 273-289  [cross-ref]

Haga clic aquí para ir a la sección de Referencias</sup> were the first to treat a series of patients for obesity with gastrointestinal surgery. Their original operation described in 1963 was the jejunocolic bypass and proved to have serious side effects as well as unacceptable mortality (Figure 1). The jejunocolic bypass was designed to be reversed after adequate weight had been lost. Restoring the intestinal continuity, however, resulted in regain of the lost weight, and Payne's subsequent work evaluated the potential of jejunoileal bypass as a long-term surgical answer to severe obesity. That work resulted in a procedure which anastamosed 14 inches of jejunum end-to-side to 4 inches of distal ileum. This jejunoileal bypass remained the standard operation for obesity until the advent of gastric procedures.<sup>127 Payne J.H., DeWind L.T. Surgical treatment of obesity Am J Surg 1969 ;  118 : 141-147  [cross-ref]

Haga clic aquí para ir a la sección de Referencias</sup> Mason and others developed gastric reduction procedures, two of which, the vertically banded gastroplasty and the roux-en-Y gastric bypass, have become the current standard for gastrointestinal obesity surgery.

As surgery for obesity has developed and improved, much has been learned from these procedures about the control of food intake and body weight in humans. This article reviews the development of these surgical approaches with an emphasis on the present state of the surgical treatment as well as the insights that have been gained into the physiologic controls of obesity.