Weight Control and Diet

Description

Alternative Names

Other Treatments

Surgical procedures for obesity (also called bariatric surgery) may be appropriate for some dangerously obese people and may reduce heart problems and many of their risk factors, including high blood pressure, sleep apnea, and diabetes. In fact, some evidence suggests that surgery may provide much greater control of weight and diabetes than nonsurgical weight-loss methods. Studies are reporting significant reductions in diabetes and need for diabetic medications. Other medical conditions that often improve after surgery include heartburn, arthritis, and other joint and circulation problems.

Bariatric surgeries produce weight loss through one of two approaches:

• Restrictive Banding Procedure. These procedures restrict the amount of food by closing off parts of the stomach with bands.
• Malabsorptive Bypass Procedures. This approach restricts the amount of food and also reduces absorption by using a by-pass of parts of the intestine.

The malabsorptive procedures are more successful in achieving weight loss than the banding approach, but they carry a greater risk for nutritional deficiencies.

Benefits of Bariatric Surgery

Most people lose about two-thirds of excess weight within two years. In addition, often diseases associated with obesity improve (e.g., diabetes, high blood pressure, sleep apnea, joint pain, and incontinence). The majority regains about to 10% of their weight, although most maintain significant weight loss. Failure can still occur if people cheat the procedure by eating frequent small meals of liquid or soft foods. Patients must still develop a healthy life style and be calorie conscious after the operation. Follow-up must be life long.

Candidates for Bariatric Surgery

Any surgical candidate must have failed consistently in losing weight through less invasive methods. Experts recommend bariatric surgery only for the following:

• Those whose BMI is above 40 (about 100 pounds overweight), and or
• Those with BMIs of over 35 who have type 2 diabetes or serious obesity-related medical problems at least 35 or more or whose weight is about 85 to 100 lb. more than ideal, and or
• Those with severe obesity that interfered with employment, normal physical activity (e.g., walking), and important relationship.

Restrictive Banding Procedures

About a third of people who undergo these procedures achieve normal weight and 80% experience some weigh loss. They are less successful than the by-pass procedures but cause a lower risk for nutritional deficiencies.

Vertical Banded Gastroplasty. Vertical banded gastroplasty (VBG) was the most common restrictive procedures. It involves creating a hole through both stomach walls and sealing the edges with a staple. This narrows the stomach, similar to a funnel, and allows only small amounts of food to pass through.

Laparoscopic Gastric Banding. Laparoscopic gastric banding (the Lap-Band) usually does not require a major incision and avoids some of the major complications of gastric bypass:

• It employs an adjustable silicone band that is placed around the upper part of the stomach.
• A small balloon-like reservoir attached to the band under the abdominal skin contains saline, which can be added or removed to tighten or loosen the band.
• The procedure restricts the amount of food a person can eat and gives the feeling of fullness.

The band is removable, if necessary. Studies to date indicate that the intestinal tract returns to normal afterward. Some studies have reported significant weight loss and improved quality of life with the procedure, including in the elderly. A 2001 analysis of eight US centers where it was performed, however, reported a very high failure rate after two years. Experts concluded that it is not, at this time, an effective procedure for severe obesity. Nevertheless, increasing surgical experience could improve these results.

Malabsorptive Bypass Procedures

Malabsorptive procedures produce greater weight loss than restrictive procedures. They generally achieve about two-thirds of their weight loss within two years. Furthermore, in a 2003 study, after standard bypass surgery, 83% of patients with type 2 diabetes experienced normal blood glucose levels and the rest had significant reductions.

Roux-en-Y Gastric Bypass Procedure. This is the most successful malabsorptive surgery. It involves creating a small stomach pouch that serves as a reservoir and restricts food intake. The pouch eventually holds up to 3 ounces of food and has a small outlet that delays emptying and causes a feeling of fullness. Then the surgeon creates a Y-shaped section in the small intestine that attaches to pouch and allows food to bypass the lower stomach and upper part of the intestine. One 2003 study reported that it was associated with significant weight loss, and furthermore 80% of patients with type 2 diabetes were able to reduce their medications.

Click the icon to see an image of gastric bypass surgery.

The procedure produces greater and more sustained weight loss than banding procedures, but also it is more complicated and carries a higher risk for nutritional deficiencies. Laparoscopy techniques, which are less invasive, are showing promise for possibly reducing complications.

Biliopanctreatic Diversion. This procedure is more complicated and removes portions of the stomach. The pouch that is created attaches directly to the lower part of the small intestine. It poses a higher risk for nutritional deficiencies than other procedures and is not used as often.

Side Effects and Complications

General Side Effects and Complications. Side effects and complications of bariatric procedures are common, and up to 25% of patients require corrective or repeat procedures. After any of these procedures people must chew all their food carefully and cannot eat large amounts of food at one time or they will experience nausea, abdominal distress, or both.

Complications from any bariatric procedure includes the following:

• Vomiting is the most common, with banding procedures causing a greater risk.
• There is a strong risk for nutritional deficiencies, particularly with malabsorptive operations. This can lead to anemia and increase the risk for bone loss and osteoporosis. Sufficient mineral and vitamin supplements are important.
• There is a significant risk for deep-vein thrombosis (blood clots).
• Abdominal hernia is a common complication. (Newer, laparoscopic technique can avoid this problem, but not all individuals are candidates for this less invasive approach.)
• Rapid weight loss after surgery puts people at high risk for gallstones.
• Women who wish to be pregnant should wait until their weight has stabilized. Rapid weight loss and nutritional deficiencies can harm the fetus.

People at highest risk for complications are those with heart or lung problems, severe obesity, and a history of abdominal surgeries. Mortality rate from bariatric surgeries is 0.2%, which is lower than the morality rates from morbid obesity itself. Other variations and less invasive techniques using laparoscopy are being developed.

Specific Complications of Restrictive Banding Procedures. Nausea, vomiting, or both in half the patients and severe heartburn in a third. Device-related complications include band slippage, pouch dilation, or both in nearly a quarter of patients and obstruction in 12%. Very serious complications are rare, but include blood clots, bleeding, infection, pneumonia, and perforation of the stomach.

Specific Complications of Malabsorptive Bypass Procedures. Vomiting often occurs. Nutritional deficiencies occur more often in these procedures. The so-called dumping syndrome is a common unpleasant side effect that occurs when food waste moves too quickly through the intestine. Symptoms include nausea, weakness, sweating, and faintness (particularly after eating sweets).

Liposuction is not recommended for major weight loss.