However, weight-loss surgery is not a quick fix or a cure. To be effective, it must be combined with a healthy diet and regular exercise.
"The surgery is a small piece of the puzzle," says Joyce Schone, RD, LD, bariatric-surgery dietitian at the University of Minnesota Medical Center-Fairview in Minneapolis. "It's a tool, but not the key."
Bariatric-Surgery Candidates
An estimated 220,000 bariatric surgeries will be performed in the United States in 2008, up from 108,000 in 2003. Candidates must usually have a body mass index (BMI) of 40 or greater, or a BMI of 35 to 39.9 and a weight-related health problem, such as diabetes or high blood pressure. (A healthy BMI is 18.5 to 24.9, a BMI of 25 to 29.9 is considered overweight, and a BMI greater than 30 is obese.)
Physicians don't approve all candidates for weight-loss surgery. Morbid obesity isn't the only factor; patients need to be medically and psychologically ready to adjust to new eating and exercising habits — along with a new body.
"Weight-loss surgery isn't for people who think it's the easy way out," says Daniel Procter, MD, who has been performing bariatric surgery for 30 years at Northeast Georgia Medical Center in Gainesville. "You must be committed to the whole process."
Types of Weight-Loss Surgery
All forms of weight-loss surgery reduce the size of your stomach and/or shorten your small intestine. This decreases the amount of food your stomach can hold and causes your intestine to absorb fewer calories. After surgery, patients typically feel full after eating about 90 percent less at a meal.
The four main types of weight-loss surgery are:
Gastric bypass (GBP). This is the most common surgery. Gastric bypass seals off a large section of your stomach, reducing the part that can hold food to the size of a golf ball. Then the surgeon attaches that part of your stomach to the middle of your small intestine, which causes food to bypass the section of your intestine that absorbs the most calories (duodenum). This surgery is also called Roux-en-Y [ROO-en-why] gastric bypass, named after a nineteenth-century French surgeon who pioneered the technique. It causes fatal complications in one out of every 300 patients. This fatality rate is higher than other procedures, but it's also more effective surgery.
Adjustable gastric band (AGB). The surgeon inserts an inflatable band around the upper part of your stomach. In the next few months, the band is gradually tightened, and your stomach is partitioned into a smaller upper pouch and a larger lower pouch. This creates a narrow passage, with the upper pouch limiting the amount of food you can eat. This technique is simpler and can have fewer complications than gastric bypass (AGB causes a fatal complication in one out of every 2,000 patients), but it's less effective.
Vertical-banded gastroplasty (VBG). Also called stomach stapling, this technique divides your stomach into a smaller upper pouch and a larger lower pouch. This limits space for food in the top portion of your stomach and causes you to eat less. Unlike AGB, VBG is not adjustable. VBG causes fatal complications in one in every hundred patients.
Biliopancreatic diversion with duodenal switch (BPDDS). Usually reserved for people who are extremely obese (with a BMI of 50 or greater), this bypass procedure involves removing a large portion of the stomach and rerouting the small intestine to allow pancreatic juices to enter the digestive process near the colon instead of mixing with food in the duodenum. This option poses a greater risk for nutritional deficiencies than the other procedures. The fatality rate is similar to gastric bypass.
Benefits of Weight-Loss Surgery
Most people who have bariatric surgery lose at least 30 percent of their excess weight within the first two years. Other benefits may include:
Type 2 diabetes is eliminated in the majority of people who have the risk of dying from heart disease may be reduced by up to 50 risk of dying from any form of cancer may be reduced by up to 60rall life-expectancy can be increased by almost 90 percent.
Risks of Weight-Loss Surgery
As mentioned, one in 300 patients die as a result of the most common bariatric-surgery procedure. Like any major surgery, all options carry risks for bleeding, infection, cardiac events, and adverse reactions to anesthesia.
A common but usually avoidable side effect of weight-loss surgery is dumping syndrome. If a patient doesn't follow the advised strictly, and eats certain foods (often sweets), food may enter the small intestine too quickly, causing symptoms such as sweating, nausea, cramps, and diarrhea.
Other complications of bariatric surgery include:
Blood clotsPneumoniaStomach leakIncision herniaGallstonesKidney stonesUlcerGastroesophageal reflux disease (GERD)Intestinal strictureMalabsorption of vitamins and mineralsAnemiaOsteoporosisDehydrationExcess skinDepression or anxiety
Last reviewed: October 6, 2008 | Last updated: October 9, 2008 This section created and produced exclusively by the editorial staff of. © 2008; all rights reserved.
