Weight Loss Surgery

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Bariatric, or weight-loss, surgery is considered for those with obesity, often morbid obesity, and serious health issues or the risk of developing serious health issues like heart disease and strokes, high blood pressure, non-alcoholic fatty liver disease, sleep apnea, and type 2 diabetes. After failing multiple attempts at weight loss and lifestyle modification, a person can be considered for bariatric surgery if their body-mass index (BMI, an estimate of body fat based on height and weight) is 40 or over or 35 to 39.9 and he/she has serious health issues like hypertension and diabetes. Rarely, a person may be recommended for a bariatric procedure if their BMI is 30 to 34 and they have very serious, life-threatening health issues. Of course, a person must be healthy enough to undergo surgery.

Prior to undergoing bariatric surgery, a prospective patient will undergo extensive medical and psychiatric screening and will be followed closely by a dietician. In addition, he/she must be willing to commit to make permanent changes in diet and lifestyle. Also, harmful eating behaviors, like binge eating, must be addressed. Women of child-bearing age should consider a reliable form of birth control, as the likelihood of pregnancy will often increase after the surgery. Some forms of bariatric surgery limit the amount that can be eaten, and some forms reduce the body’s ability to absorb nutrients. Some procedures do both. Bariatric surgery is expensive and may not be fully covered by health insurance.

There are several types of bariatric surgery. All involve changes to the stomach, especially to the fundus, or top of the stomach. The fundus is where most of the hunger-inducing hormone ghrelin is produced in response to an empty stomach. There is the gastric bypass, known as a Roux-en-Y gastrectomy, where a walnut-sized stomach pouch is created and is connected to the mid small intestine.

In a sleeve gastrectomy, half of the stomach plus most of the fundus is removed, leaving only about one third of the stomach still intact. There is also a biliopancreatic diversion with a duodenal switch, which is too complicated for this discussion. Sleeve gastrectomy usually results in more weight loss than the less-invasive adjustable gastric band procedure, but it produces less weight loss than gastric bypass. Like any surgery, bariatric surgery has risks. There are immediate, or short-term risks, like bleeding, infection, blood clots, anesthesia reactions, anastomotic leaks (anastomosis is the process of connecting, or sewing, hollow tissues to each other), and breathing problems. Long term risks include intestinal obstruction or blockage, gallstones, hernias, malnutrition, ulcers, reflux symptoms, and vomiting. The risk of death, either short or long term, is thankfully very low.

Patients, especially after sleeve gastrectomy, are generally able to resume their usual activities shortly after surgery. Most patients will have a reduced appetite, although they are still able to enjoy food and participate normally in social activities. Most patients report improved quality of life.

For more information go to:

medlineplus.gov/ency/article/007435.htm and medlineplus.gov/weightlosssurgery.html 

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By Peter Galvin, MD

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