For some people, dieting and exercise never work. They remain obese even after years of trying to lose weight. But obesity is associated with a host of ills, including high blood pressure, diabetes and heart disease. It can also be a source of low self-esteem and depression. So for people who feel they'll never be able to get to a normal weight on their own, surgical weight loss, known as a bariatric procedure, can be an attractive option.
The Basics
Bariatric procedures involve altering your stomach so that calorie intake is limited. Several different procedures are available, each with different risks, benefits and requirements. Generally, a doctor may feel you're a good candidate for an operation if you meet any of these criteria:
-You're at least 100 pounds overweight or your body-mass index is 40 or higher.
-Your body-mass index is 35 or higher and you have a coexisting, obesity-related medical condition.
-You've made serious attempts at losing weight but have failed. By serious, doctors mean, for example, techniques such as behavior modification, a diet prescribed by a physician, behavior modification and groups such as Weight Watchers.
Roux-en-Y Gastric Bypass
Roux-en-Y gastric bypass involves bypassing the majority of the stomach, along with the initial two feet or so of the small intestine. After surgery your stomach will feel full much more rapidly, owing to its reduced size. Additionally, calorie absorption is reduced because the food is in contact with the small intestine for a shorter period.
There are a couple of variations available for this surgery. It can be done laparoscopically, with as many as a half-dozen small incisions rather than one large incision. Long, thin tubes are used to guide tools into place through the incisions. The idea is to create less scarring, less pain and a quicker recovery.
A procedure called distal gastric bypass is sometimes performed on patients more than 200 pounds overweight. Essentially, a larger portion of the small intestine is bypassed. This procedure increases the risk of nutritional complications.
Biliopancreatic Diversion
In biliopancreatic diversion, a surgeon reduces capacity of the stomach by a modest amount and performs a more extreme bypass than in the Roux-en-Y procedure. This operation is for the heaviest people, and is increasingly popular. Like distal gastric bypass, biliopancreatic diversion can cause the patient to have trouble getting adequate nutrition.
Adjustable Gastric Band
A surgeon can install an adjustable gastric band to limit a patient's caloric intake. It's an inflatable band that forms a circle around the stomach and can be adjusted as the patient's needs change. Since it does not involve changing the small intestine, it doesn't carry a high risk of nutritional deficiencies. However, weight loss is less than in the other procedures, so it's often recommended for patients whose obesity is not as severe. It is the bariatric procedure with the least surgical risk.
Gastroplasty
Gastroplasty is also known as stomach-stapling surgery. With staples and a band, a surgeon fashions a small pouch from the upper portion of the stomach, with an approximately 1 cm hole at its bottom. This restricts the passage of food into the lower part of the stomach and the intestines. This procedure is losing popularity as surgeons and patients choose procedures involving a gastric bypass component, leading to more effecting and lasting weight loss, or an adjustable gastric band, leading to fewer complications.
Tags: gastric bypass, small intestine, weight loss, adjustable gastric, band, bariatric procedure, behavior modification