Maturitas 66 (2010) 223–230 Contents lists available at ScienceDirect Maturitas journal homepage: www.elsevier.com/locate/maturitas Review Preventing and treating the accelerated ageing of obesity John G. Kral a,b,∗ , Philip Otterbeck b,c , Mariana Garcia Touza b,c a Department of Surgery, SUNY Downstate Medical Center, Brooklyn, NY, USA b Department of Medicine, SUNY Downstate Medical Center, Brooklyn, NY, USA c Division of Endocrinology, SUNY Downstate Medical Center, Brooklyn, NY, USA article info Article history: Received 12 February 2010 Received in revised form 19 February 2010 Accepted 19 February 2010 Keywords: Calorie restriction Cancer Eating behavior Inflammation Osteoarthritis Transplantation abstract Advances in the molecular biology of ageing, insulin resistance, inflammation, carcinogenesis and caloric restriction have elucidated commonalities relevant to the chronic overnutrition syndrome termed obe- sity. Not until the expanded acceptance and availability of surgical treatment of obesity (“bariatric surgery”) has it been possible to explore the beneficial effects of sustained voluntary weight loss through controlled undernutrition in freely living people. Bariatric surgery is 58 years old and has undergone dramatic improvements recently becoming significantly safer and more accessible owing to the devel- opment of minimally invasive approaches and other advances. Furthermore, it is cost-effective compared to all forms of non-operative treatment. Thus older candidates, with more numerous and severe comor- bidities are being recruited, increasing the pool of patients who have had operations which extend the otherwise shorter lives of the obese. Here we describe two mechanistically different operations, gastric restrictive and diversionary, and address their risks, complications, side-effects and beneficial outcomes, in aggregate increasing longevity, reducing morbidity and most important: improving health-related quality-adjusted life years. © 2010 Elsevier Ireland Ltd. All rights reserved. Contents 1. Introduction .......................................................................................................................................... 224 2. Risks of operating the elderly ........................................................................................................................ 224 3. Types of bariatric operations ........................................................................................................................ 225 3.1. Malabsorptive ................................................................................................................................ 225 3.2. Diversionary .................................................................................................................................. 225 3.3. Restrictive .................................................................................................................................... 225 3.4. Combinations ................................................................................................................................. 225 3.5. Recent developments ........................................................................................................................ 225 3.5.1. Minimally invasive ................................................................................................................. 225 3.5.2. Electrostimulation .................................................................................................................. 226 4. Mechanisms of bariatric operations ................................................................................................................. 226 4.1. Implications and conclusion ................................................................................................................. 226 5. Complications ........................................................................................................................................ 226 5.1. Surgical mortality ............................................................................................................................ 226 5.2. Perioperative complications ................................................................................................................. 226 5.3. Long-term postoperative complications ..................................................................................................... 226 5.3.1. Surgical ............................................................................................................................. 226 5.3.2. Nutritional .......................................................................................................................... 226 5.4. Risk of undernutrition ........................................................................................................................ 227 ∗ Corresponding author at: Department of Surgery, Box 40, SUNY Downstate Medical Center, 450 Clarkson Ave, Brooklyn, NY 11203, USA. Tel.: +1 718 270 1955; fax: +1 718 270 1317. E-mail address: jkral@downstate.edu (J.G. Kral). 0378-5122/$ – see front matter © 2010 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.maturitas.2010.02.011