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Understanding Surgical Options for Obesity

Metabolic Syndrome

If you struggle with clinically severe obesity and have been unable to reduce your weight by lifestyle changes, your health care provider may recommend surgery. Many people, including some health care professionals, wrongly believe that obese people merely need to stop eating so much to lose weight. In reality, extreme obesity is a potentially deadly disease that sometimes requires a treatment as dramatic as surgery. Surgery is an option for carefully selected patients under the care of a health care professional. The surgery, called bariatric surgery, reduces the size of your stomach, limiting the amount of food it can hold. Most physicians consider people for the surgery who:

  • have tried other methods of weight loss (changes in eating behavior, increased physical activity and/or drug therapy) and are still severely obese
  • have a BMI of at least 40 (or 35 in addition to other medical conditions such as diabetes, hypertension and heart failure)
  • understand the procedure, risks of surgery and effects after surgery
  • are motivated to make a lifelong behavioral commitment that includes well-balanced eating and physical activity needed to achieve-and maintain-desired results

There are several types of bariatric surgery:

  • Roux-en-Y gastric bypass (RYGB). In this procedure, sometimes known as "stomach stapling," the stomach is reduced to the size of a golf ball. The stomach is divided into a large portion and a small portion. The small portion is sewn or stapled together to make a small pouch, which holds only about a cup of food. The small pouch is then disconnected from the upper portion of the digestive tract and reconnected to a lower portion of the intestine. Not only do you eat fewer calories, but your body absorbs fewer calories because part of the intestine, the duodenum, has been bypassed.
  • Adjustable gastric band. This procedure is performed laparoscopically, through a small incision in the abdomen. The surgeon wraps a saline-filled silicone band around the top of the stomach to create a small pouch about the size of a thumb. The size of the pouch can be altered by increasing or decreasing the amount of saline (salt water) in the pouch. You eat less because you feel full sooner.

Other less common procedures include:

  • Biliopancreatic bypass with duodenal switch (BPDS). In this procedure, much of the stomach is removed, leaving only a "gastric sleeve" that is attached to the small intestine, completely bypassing the duodenum and upper small intestine.In a similar procedure, called biliopancreatic diversion with duodenal switch, a smaller portion of the stomach is removed, and the remaining stomach (gastric sleeve) remains attached to the duodenum. The duodenum is connected to the lower part of the small intestine. As with the gastric bypass procedure, you absorb fewer calories with both of these procedures. You also eat less because your stomach is so much smaller. Removing part of the stomach is also thought to reduce production of an appetite-related hormone called grehlin.
  • Gastric sleeve. This procedure is actually the first part of the surgery performed in the BPDS, only the remaining pouch does not bypass the intestine. About three-quarters of the stomach is removed, and the remaining narrow pouch-or sleeve-connects to the intestines This procedure seems to be effective on its own and has shown excellent results, although it is still considered investigational.

All procedures can lead to "full and rapid" remission of diabetes, sleep apnea, hypertension, kidney failure and other weight-related medical conditions.

While bariatric surgery is extremely safe, the greatest risks come after the surgery. Some occur soon after the operation, such as hemorrhage, obstruction, infection, hernias, pulmonary embolisms (blood clots in the lung) and leaks between the areas where tissue was sewn together.

Long-term complications include nutritional deficiencies, including malabsorption of vitamin B12, iron and calcium; and hypoglycemia, or low blood sugar, which can lead to various medical conditions, including neuropathy.

Most people undergoing bariatric surgery have rapid and extreme weight loss. In one study of 608 patients followed up to 16 years, the average weight loss was 106 pounds. Nearly all the weight is lost by the second year after surgery. An estimated five to 10 percent of patients do not lose much weight, or regain the weight, with higher rates seen in those who undergo the gastric banding procedure.

After surgery, you have to learn to eat smaller amounts of food at one time, to chew food well and to eat slowly. If you don't adjust your eating habits, you won't lose as much weight. Additionally, especially in the first three months after surgery, you must be sure to eat the proper amounts of protein, calories, minerals and vitamins as recommended by your health care professional and you will likely need nutritional supplements for the rest of your life.

If you're considering surgery, make sure to spend time researching specialists, and get opinions from various health professionals. Plus, you'll want to learn as much as you can about the procedure and follow-up care. You also might want to consider attending a support group where you can meet and talk with people who have been in your position.

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