Treating Obesity: Bariatric Surgery
Welcome to the fourth installment of this week’s series examining the causes, dangers, costs and treatments for obesity. So far we have discussed why people develop obesity, as well as some of the more popular dietary and drug treatments. Today we’ll look at surgical interventions.
As we have seen in previous blogs, most people who undertake a serious weight loss program using diet and exercise do manage to lose weight; some a dramatic amount of weight. However, studies show that over 90% of them will quickly regain that weight, and usually more. Pharmacological or drug treatments have also proven to be moderately successful with helping the patient lose weight, but as with diet and exercise, most people regain the weight within a short time of stopping the medications. But, don’t lose hope there are other options including weight loss or bariatric surgery.
Bariatric surgery is not for everyone. These surgeries are usually reserved for women who are at least 80 pounds overweight and for men who are 100 pounds or more overweight. People who need to lose smaller (but still significant) amounts of weight may also qualify for the surgeries if they have complicating medical conditions such as diabetes, sleep apnea, chronic high blood pressure and joint pain.
There are several different types of procedures, but they all work in similar ways in that they restrict the amount of food a patient can take in, and some procedures also limit the amount of food the person can digest. They are also alike in that, unless the person makes permanent changes in their lifestyle, such as changing the type and amount of food they eat, not consuming liquids with their meals, and increasing physical activity, the person is almost certain to regain their lost weight.
Having said all he above, the four most common bariatric surgeries are:
Laparoscopic adjustable gastric banding (LAGB): In this procedure, the stomach is separated into two pouches with an inflatable band. Pulling the band tight, like a belt, the surgeon creates a tiny channel between the two pouches. The band keeps the opening from expanding and is generally designed to stay in place permanently. LAGB is popular because it is less invasive, generally causes slow, steady weight loss and the band can be adjusted if needed.
Gastric Sleeve: This procedure has become much more popular with both patients and surgeons over the past three to five years. In this procedure, the surgeon removes about 75% of the patient’s stomach resulting in a pouch with a banana-like or sleeve appearance. As with the band, most of these procedures are done laparoscopically.
Biliopancreatic diversion with duodenal switch: This is the first of the procedures that combines stomach restriction and malabsorption. In this procedure the surgeon removes about 70% of the stomach and then attaches a portion of the small intestine to the new stomach. This results in the patient being able to consume less food at one time, limits the amount of time the body has to digest the food and also interferes with the absorption of fat.
Gastric bypass or Roux-en-Y: This is generally considered the gold standard of bariatric surgeries because it has shown relatively good long-term results. In this procedure, the surgeon creates a small pouch at the top of the stomach by bypassing 75 to 80% of the organ. (S)he then cuts the small intestine a short distance below the main stomach and attaches it to the new pouch. Food and liquid flow directly from the pouch into this part of the intestine, bypassing most of the stomach.
So, as we have seen, bariatric surgery is, by far the most effective method of helping people to lose weight and keep it off. However it isn’t for everyone. First, the patient has to be morbidly obese to qualify for the surgery. Also, the patient has to be willing and able to commit to making drastic and permanent changes to their lifestyle.
In the interest of full disclosure, I had Roux-en-Y surgery over three years ago. Since then I have lost over 135 pounds and kept it off. However, in addition to the surgery I had to completely change what, when and how I eat as well as dramatically increasing the amount of exercise I do. Given the need and opportunity, I would do it all over again in a moment!