Bariatric surgery has finally been recognized as the only treatment for morbid obesity with successful outcomes in long-term follow-up. Although the ultimate solution for treatment of this disease may involve metabolic or genetic manipulations, currently no such treatments generate weight loss results and improvements in medical co-morbid conditions which compare to surgical treatment. However, despite successful outcomes and published low complication rates in major centers, bariatric surgery is often viewed by the public and prospective patients as a drastic, invasive, and high risk solution. The American public does not uniformly embrace the surgical treatment option for morbidly obese patients. Letters to People magazine, even in the aftermath of celebrity Carnie Wilson's highly successful gastric bypass surgery, sadly reveal the altogether too frequent prejudice and innuendo about laziness, sloth, and below average intelligence that sufferers of morbid obesity must endure as once again the public demonstrates that they do not understand obesity and are unsympathetic to its victims.

In contrast to the stereotypes of morbidly obese patients, bariatric surgeons recognize that there is no more rewarding area of surgical specialization than treatment of the morbidly obese patient. Obese patients are often highly motivated to reclaim a more normal life and eliminate their co-morbid medical problems. Our co-editor Harvey Sugerman has expressed it best: "Bariatric surgery is like no other treatment in medicine. There is no other situation in which a surgeon can perform a single surgical procedure and cure 4 or 5 of the patient's medical problems." Despite the challenges and pitfalls of caring for obese patients, a successful surgical outcome usually leads to an extremely grateful patient and family.

The introduction of minimally invasive surgical approaches to treat obesity has led to a tremendous interest in bariatric surgery in the United States and around the world. Laparoscopic surgery represents a tremendous opportunity to ameliorate the public's fear that surgical treatment is too drastic and invasive to be considered a reasonable choice for the estimated 12 million Americans who could benefit greatly from successful weight loss. This challenging new area of specialization within bariatric surgery represents a dramatic opportunity to help so many, yet it is fraught with myriad obstacles for safe development. There is no more technically demanding laparoscopic procedure being offered on a routine basis today than laparoscopic Roux-en-Y proximal gastric bypass. Furthermore, training and skill in advanced laparoscopy are an inadequate background for developing a program since the bariatric patient presents many complex issues in management for the surgeon. Thus, the novice must master the skills of two disciplines: advanced laparoscopy and bariatric surgical care.

This text provides a resource to surgeons committed to bringing safe and effective laparoscopic treatment to their morbidly obese patients. Its rapid publication addresses the usual concerns that textbooks lag significantly behind developments in the field, a phenomenon which would have been totally unacceptable in this rapidly emerging field. Each chapter addresses issues which are critical to the safe application of minimally invasive techniques to the unique population of morbidly obese patients. The authors bring forward their experience in bariatric surgery and lessons learned from the development of their laparoscopic obesity surgery program.

The Editors

Chapter 2

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Diet Tweak System

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