The continuous increase in body weight observed in most of the so-called ‘civilised’ countries worldwide over the last few decades is contributing to a health economics problem of immense dimensions. Obesity-associated morbidities, with type 2 diabetes mellitus being the most prominent, are responsible for a continuously growing financial burden to every social and health care system.
The main reason for this problem is the observed increase of overconsumption of food due to a lack of appetite control and a mainly passive (sedentary) lifestyle based on steadily decreasing physical activity which leads to a pathological energy balance and obesity.
This development causes a situation where one out of every five American dollars spent on health care in the United States of America is for the treatment of obesity.1
Therefore, this issue of Hamdan Medical Journal is focusing on this immense health problem and offers its readers the latest state-of-the-art reviews dealing with the pathophysiology as well as the newest treatment options.
The conservative approach is focusing more and more on appetite control as well as the propagation of physical exercise and education, especially in childhood.
It is concisely shown (also in an original paper in this issue) that an educational programme for children is absolutely mandatory in avoiding increasing numbers of severely obese children and teenagers.
Furthermore, an interesting overview by Langer and Prager from Austria covers the issue of ‘metabolic surgery’, which has repeatedly proven to be the most effective therapeutic approach to obesity-associated type 2 diabetes mellitus. Owing to the technical improvement by minimal invasive (laparoscopic) surgery, as well as newer techniques (which will still have to prove their efficacy in the long-term follow-up), the number of bariatric procedures performed annually worldwide increased from 146 301 in 2003 to 344 221 in 2008.2
The successful reduction in weight and the need for antidiabetic medication, together with a low surgical morbidity and mortality, has led to a permanent discussion about the indication for identifying candidates for weight loss surgery, thus recommending this type of treatment for patients who are already below the ‘old’ standard level of a body mass index of 40 kg/m2 as suggested a decade ago.
I am more than grateful for these excellent keynote articles which I hope will give our readers a full insight into this important topic.