Update: Surgery for the Morbidly Obest Patient. The field of Extreme Obesity Including Laparoscopy and Allied Care
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* Simon Biron

**UPDATE: SURGERY FOR THE MORBIDLY OBEST PATIENT. THE FIELD OF EXTREME OBESITY INCLUDING LAPAROSCOPY AND ALLIED CARE. Edited by Mervyn Deitel and Georger S.M. Cowan Jr. 539 pp. Illust. FD-Communications Inc., Toronto, 2000. US$195. ISBN 0-9684426-1-7**

Massive obesity and its associated diseases are a recognized health issue. As indicated by the American National Institute of Health Consensus, surgery is at present the only effective treatment for morbid obesity. Any physician involved in treating the diseases associated with morbid obesity or the surgical treatment of this disease should refer to this book, which has 88 contributors, each selected because of his or her particular interest and expertise in this field.

The foreword written by Edward E. Mason, emeritus professor of surgery at the University of Iowa and recognized among bariatric surgeons as a pioneer, gives a clear overview of the book.

The first 6 chapters establish the problem of massive obesity. The etiology and genetics are presented clearly by Bouchard and his colleagues. Eating and weight disorders are clarified and pinpoint the relatively more intense physiologic defences against weight loss than weight gain. Resting energy expenditure may be best determined by indirect colorimetry instead of by equations and tables. Insulin resistance and type 2 diabetes mellitus, and many other medical problems, appear to be more a side effect of the disease called obesity.

There follow 5 chapters presenting the surgical procedures available, pertinent physiology, the semantics of obesity surgery, performance standards, operative indications and special concerns in anesthesia for severely obese patients. With this background material, the reader can evaluate the remaining chapters, which present in detail specific operations and problems associated with this special field of surgery.

All the authors seem to be very involved in making their respective chapters clear and easily read. The editors make no distinction among the various approaches to bariatric surgery, and surgical complications as well as their consequences are well documented.

Obesity surgery can be of great benefit when performed by surgeons dedicated to the study of the subject and to the care of their patients. This book provides an excellent introduction to the subject. For the obesity surgeon there is always more to learn and this book provides appropriate references. Those who are not and do not intend to become obesity surgeons will be better informed about the obesity epidemic, its impact and the surgical challenge it presents.

This book is a valuable reference on morbidy obesity.