Weight Loss Surgery - An Option for Obesity
We have written before that one factor that reduces healthy aging is gaining weight, not a little but a lot of weight. Very recently we wrote that as we age we almost all inevitably gain weight in places that we would prefer it not be. However, some weight gain is expected with aging, but it the individual that becomes excessively overweight that incurs serious health risks.
The typical strategies of dealing with weight gain involve two choices we make: what (and how much) we eat and what exercises we do to work off the calories we ingest. To eat healthy foods in moderate amounts sounds simple, but for some it is not. Likewise, going for a walk every day or even more intensive exercise at least 3 times a week is possible for most, but not all. Once one begins to become obese, exercise is difficult and consumption of less than ideal food is a habit hard to break. This leads to progressive weight gain.
Surgery is generally a late option for many diseases, and this is certainly true of obesity. There are now two general surgical approaches to obesity. One is gastric bypass and the other is gastric banding. Gastric bypass and banding are increasing in their use and it is estimated that well over 200,000 such procedures will be done each year in this country. They are also performed all around the world as a cost-effective approach to the morbidly obese (grossly obese with body mass index over 40 or moderate-to-severe obesity of BMI between 30 and 40) epidemic world-wide. (It is interesting that although surgery has proven to be a cost-effective treatment over 20 years that many insurers will not pay for this type of surgery.)
Gastric Bypass Surgery
Gastric bypass surgery was developed in the 1960’s and 1970’s after it was observed that patients with ulcer who had partial stomach removals ate less and loss weight. Further understanding of just how digestion and absorption of calories and minerals led to the current day’s most popular approach. This approach is termed “restrictive” and “malabsorptive” because a small stomach pouch is created and eaten material is shunted past parts of the digestive track. The result is someone with this surgery tends to feel more full and all that is eaten is not digested and absorbed.
Gastric bypass surgery can be performed with a large incision (open) or with laparoscopic methods (small multiple incisions) using cameras inside the body for vision rather than direct vision. Both are effective means of doing this surgery, but the laparoscopic is less invasive and has a more rapid recovery time and fewer overall complications.
Complications with either technique can be minor such as incision infection to major like death (0.5% or 1 in 200 patients). Longer term complications include some deficiency of certain vitamins and minerals that require supplemental pills. In one to two months, patients are usually back to normal routines and within 2 years are expected to lose about 60% of their abnormal weight.
The procedure of gastric banding involves surgery that places a synthetic material band around the stomach that can be adjusted by injecting or withdrawing saline from the inflatable tube in the band. This procedure is a restrictive procedure, making the stomach feel full and the patient less inclined to eat great quantities of food. This procedure like the gastric bypass can be performed with direct vision (larger incision) or with laparoscopy (smaller incisions). In general banding is effective, but not as effective as gastric bypass in the primary aim of reducing weight. Complications are similar to those with gastric bypass, but because there are no internal anastomosis (cutting and sewing of stomach and bowel) there are fewer chances for abdominal infection.
Who Should Consider Surgery?
Patients who are grossly overweight and have tried a great variety of non-surgical approaches to weight loss are candidates for surgery, if they, their family and their physicians agree. A rule of thumb is that anyone who has a body mass index of over 40 should consider this if they have failed with good faith non-surgical approaches to weight loss. Another way to think about candidacy is if you are male and 100 pounds over your ideal body weight or female and 80 pounds over ideal body weight you may be a candidate. If you are obese and have type 2 diabetes, heart disease and other medical problems this may make you a candidate as well.
Results of Surgery
It is important to say that there are a lot of possible adverse complications to this surgery, and even the most experienced and competent surgeon will have patients who develop minor or major complications. Thus, this surgery is reserved for those who are at a point where the risks of the surgery are exceeded by the health risks of remaining markedly obese.
Weight loss is expected with bypass surgery and banding. Also there are additional benefits beyond weight loss. Quality life indicators are improved and the weight tends to stay off indefinitely, unlike with diets. There is a very recent paper in the American Journal of Cardiology that shows that the heart of morbidly obese surgically treated patients becomes more normal in function and shape as the weight comes off. Presumably, this means there is less chance of heart failure. Lipids are improved and diabetes as well with the surgery.
If the reader or a family member is a candidate for surgery there is one final reminder. The surgery does not cure the disease or change the patient: the patient should only do this with the full intention of adhering to strict dietary and exercise guidelines after surgery. In other words, the person has to change – surgery can help, but in the end surgery is just one big step down a new road of healthy aging.
Weight Loss Surgery at MUSC
Preparing for Weight Loss Surgery
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