Bariatric surgery is a popular treatment option for morbidly obese people who have not been able to experience sufficient weight loss. Morbid obesity can lead to diabetes, heart disease, high blood pressure, cancer and many other serious conditions. Over 800,000 people have undergone this procedure, also commonly referred to as weight loss surgery.
Morbid obesity is classified as a Body Mass Index (BMI) of 40 or more, which equals being 100 pounds or more over ideal body weight. This condition leads to difficulty performing everyday tasks and may cause serious complications and a shorter life expectancy. The quality of life is also low in morbidly obese people. The causes of morbid obesity can vary but often include a combination of genetic, environmental and social factors.
There are several different types of bariatric surgery, but most focus on reducing the size of the stomach. This causes patients to feel full faster and therefore eat less food. After surgery, a proper balanced diet is required to help lose weight in a healthy way and keep it off. While these restrictive procedures are most common, others use a malabsorptive technique that does not allow the small intestine to absorb all the calories that a person takes in, and some combine restrictive and malabsorptive techniques.
Some of the most common bariatric procedures include:
- Gastric Bypass – This is a combination procedure and is the most popular weight loss surgery. Gastric bypass creates a pouch from the top of the stomach and connect it to a section of the small intestine, causing food to bypass the large intestine and limiting the body from absorbing fat.
- Gastric Banding – This is a restrictive procedure that implants a silicone band around part of the stomach and molds it into two different areas. An injection port is also attached to the abdominal wall and connected to the band and used to adjust the band.
- Sleeve Gastrectomy – Compared to the gastric bypass and banding this procedure is newer. It started as the first operation of two for patients with a very high BMI in the past. Those patients did very well and some did not require a second procedure so it became a definitive option. It is a restrictive operation where a segment of the stomach is removed creating a long tube that will hold approximately 10% of the original capacity thus achieving satiety earlier.
Roux-en-Y gastric bypass surgery is performed to help severely obese patients lose significant amounts of weight. The surgeon uses suture-like staples to separate a portion of the top of the stomach and create a pouch, which is then connected directly to a section of the small intestine called a Roux limb. (This and the Y-shaped junction between the large and small intestines give the procedure its name.) Bypassing the majority of the stomach and the large intestine, or duodenum, limits the body’s ability to absorb fat from food. Creation of the smaller stomach pouch restricts the amount of food that can be digested at any time. This combination of malabsorptive and restrictive techniques makes the Roux-en-Y procedure one of the most successful gastric bypass surgeries.
Bypass surgery may take several hours to complete, and hospital recovery time usually lasts 4-5 days. Patients who qualify for minimally invasive (laparoscopic) surgery have smaller scars, lower risk of hernias, less post-operative discomfort and shorter recovery time. A liquid diet supplemented with pureed foods must be followed for several weeks after the procedure. Potential complications include:
- Gastritis (inflammation of the stomach lining)
- Iron, calcium, or vitamin B-12 deficiency
- “Dumping syndrome” – A condition where food empties too quickly into the small intestine, resulting in nausea, cramping, vomiting, diarrhea, bloated feeling, dizziness, sweating.
- Further surgeries to correct complications or tighten loose skin
After surgery, the patient’s stomach can hold about a tablespoon of food. This will expand over time but will not exceed one cup. A normal stomach holds one quart. Because stomach size is substantially and permanently reduced, patients are limited in the amount of food they can eat in a single meal and do not suffer from constant hunger. Smaller meals eaten throughout the day are recommended rather than less frequent, larger meals.
Although the Y-connection allows pancreatic fluid and bile to aid in absorption of nutrients, bypass of the large intestine from the digestive process may result in insufficient absorption of vitamins and minerals, in addition to the desired reduction in fat absorption. Regular meetings with the surgeon and a dietitian will be scheduled before and after surgery to establish a diet and exercise plan to determine whether nutritional supplements are necessary. These appointments will take place regularly in the first year following surgery and less frequently afterward.
Bypass surgery is not a quick fix. Patients who undergo the procedure must be willing to make life changes to achieve and maintain weight loss and to prevent complications from the surgery. But with determination, good nutrition and regular exercise, the results can be dramatic: Most patients lose about 1-2 pounds per week and reach a stable weight 18 to 24 months after surgery. Weight loss occurs most rapidly immediately after surgery. Patients often also enjoy relief from weight-related illnesses such as sleep apnea, type 2 diabetes, high blood pressure, heartburn and incontinence.
Body Mass Index (BMI) is a calculation based on height and weight that measures body fat and determines classes of weight. A normal BMI is 18-25. Candidates for bariatric surgery typically have a Body Mass Index or BMI of 40 or more, or a BMI of 35 with a serious illness that can be improved with weight loss. Other factors taken into consideration include the patient’s physical and mental health and ability to follow a strict diet and exercise program. Patients interested in this procedure should schedule a consultation with their physician.