Weight Loss Surgery

Whom is the Weight Loss Surgery for ?

Also called: Bariatric surgery, Bypass surgery, Gastric banding, Obesity surgery.Weight Loss Surgery are recommended ONLY for people with severe obesity who have not responded to diet, exercise, or medication. For those with less severe obesity, the risks of the surgical procedure may outweight any potential benefits. Candidates should be sure they understand the implications of bariatric surgery and are willing to commit to the lifestyle changes necessary for reaching and maintaining a healthy weight after the surgical procedure.

The National Institutes of Health recommend that surgery be considered for people at the following weight levels:

• Patients with a body mass index >40 kg/m2
• Patients with a body mass index between 35 and 40 kg/m2 who also have serious medical problems (including diabetes, disabling joint conditions such as arthritis, or obstructive sleep apnea) that would improve with weight loss.

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How Weight Loss Surgery Works ?

There are two main categories of surgery that promote weight loss:

• Restrictive procedures, which include gastric banding, gastric bypass, and vertical banded gastroplasty, limit the amount of food the stomach can hold by closing off or removing parts of the stomach. This type of surgery does not interfere with the normal digestive process; it prevents you from eating large amounts of food at one time.
• Malabsorptive procedures, such as the biliopancreatic diversion and the Roux-en-Y gastric bypass (RGB), limit the calories and the amount of nutrients that can be absorbed by the intestine in addition to reducing the size of the stomach. In the RGB procedure, a surgeon first creates a small stomach pouch, then makes a direct connection from the pouch to a lower segment of the small intestine, bypassing large portions of the digestive tract that absorb calories and nutrients.

Benefits

 Weight loss: Immediately following surgery, most patients lose weight rapidly and continue to do so until 18 to 24 months after the procedure. Although most patients then start to regain some of their lost weight, few regain it all.
Obesity-related conditions improve: For example, in one study, blood sugar levels of most obese patients with diabetes returned to normal after surgery. Nearly all patients whose blood sugar levels did not return to normal were older or had diabetes for a long time.

Risks and Side Effects

1. Vomiting: This is a common risk of restrictive surgery caused by the small stomach being overly stretched by food particles that have not been chewed well.
2. "Dumping syndrome:" Caused by malabsorptive surgery, this is when stomach contents move too rapidly through the small intestine. Symptoms include nausea, weakness, sweating, faintness and, occasionally, diarrhea after eating, as well as the inability to eat sweets without becoming extremely weak.
3. Nutritional deficiencies: Patients who have weight-loss surgery may develop nutritional deficiencies such as anemia, osteoporosis, and metabolic bone disease. These deficiencies can be avoided if vitamin and mineral intakes are maintained.
   Complications: Some patients who have weight-loss operations require follow-up operations to correct
4. complications. Complications can include abdominal hernias, infections, breakdown of the staple line (used to make the stomach smaller), and stretched stomach outlets (when the stomach returns to its normal size).
5. Gallstones: More than one-third of obese patients who have gastric surgery develop gallstones. Gallstones are clumps of cholesterol and other matter that form in the gallbladder. During rapid or substantial weight loss a person's risk of developing gallstones increases. They can be prevented with supplemental bile salts taken for the first six months after surgery.
6. Need to temporarily avoid pregnancy: Women of childbearing age should avoid pregnancy until their weight becomes stable because rapid weight loss and nutritional deficiencies can harm a developing fetus.
7. Side effects: These include nausea, vomiting, bloating, diarrhea, excessive sweating, increased gas and dizziness.
   Lifestyle changes: Patients with extensive bypasses of the normal digestive process require not only close monitoring, but also life-long diet and exercise modifications and vitamin and mineral supplementation.

Life after Weight Loss Surgery

You will need to follow strict eating instructions provided by your health-care team after weight-loss surgery. In the early weeks, it may be difficult to eat anything without feeling uncomfortably full, and your stomach may still be very tender. Depending on the type of surgery, you may be on a liquid diet for several weeks. Gradually, you will work up to eating soft, easily chewable foods and then progress to frequent, small meals (about two ounces each). The actual number of meals may vary from four to six a day. Not only do you need to adjust to eating more frequently and consuming smaller amounts of food, but you will also need to eat slowly and chew your food thoroughly. Initially, you won't be able to drink fluid with meals because it can cause discomfort. Instead, you'll drink fluids 1/2 to 1 hour after meals. You will receive lists of suggested foods to eat and foods to avoid. In general, you will need to eat foods higher in protein and low in fat.