Obesity Surgery: Weighing the Benefits

Bariatric surgery, or obesity surgery, which includes gastric banding and gastric bypass, is not for everyone. But for some individuals the benefits may outweigh the risks. Individuals with severe or morbid obesity who have a BMI over 40 or individuals with a BMI over 35 and other obesity related health problems are good candidates for obesity surgery.


The surgery promotes rapid weight loss and minimal regaining of weight. And, the weight loss also improves the obesity-related health complications of hypertension, type 2 diabetes, sleep apnea and heart disease. Obesity surgery requires careful consideration since this surgery cannot be reversed at a later date.

 

The objective of obesity surgery is to alter the way the body digests and absorbs food. Digestion involves the breakdown of foods into nutrients like carbohydrates, proteins, fats, and other vitamins and minerals. Once the foods have been broken down into small particles they are absorbed into the cells to provide the body with energy. Because this process occurs primarily in the stomach and small intestine, obesity surgery is limited to these areas.

Gastric bypass surgery uses stomach stapling to form a small pouch and to close off the rest of the stomach. The new stomach pouch is then surgically attached to the esophagus and the small intestine. In many cases, a portion of the stomach is removed. Gastric bypass surgery can be done with an open or laparoscopic procedure. Laparoscopy means less damage to tissues and faster recovery; however the procedure requires a skilled surgeon and is not recommended for people who are severely obese. If laparoscopy is recommended verify your surgeon's credentials.

Gastric bypass surgery reduces the amount of food that can be held in the stomach. After stomach stapling, between half a cup to a cup of food can be held in the pouch, as opposed to four cups of food in a stomach that hasn't had a gastric bypass.

During the first few days following the bypass only clear liquids are allowed (the patient is usually hospitalized during this period). During the next week to two weeks low-fat high-protein liquids, such as breakfast drinks, protein shakes and low-salt beef or chicken broth, are introduced. Sometime during the weeks following surgery the doctor will recommend introducing very soft or pureed foods, such as tofu, cottage cheese, egg whites and soft fish. Approximately eight weeks after surgery (for some it may be later) the patient is back to a "regular" diet. Carbonated beverages and alcohol should be avoided.

Gastric bypass surgery decreases the amount of food that can be eaten, and also reduces weight through malabsorption: The food does not sit in the stomach pouch long enough to be fully digested. As a result, nutritional problems such as anemia or osteoporosis may occur. Most people have to take nutritional supplements after a gastric bypass. High fat foods must be restricted or diarrhea will result.

Eating too fast, or too much, after the surgery may cause intestinal dumping. The food moves into the small intestine too quickly, leading to dizziness, abdominal cramping, vomiting or diarrhea. Most post-op gastric bypass patients can eat three to four small meals a day, each averaging one-cup of food.

Some cases may require additional surgery to correct complications, gallstones, and the deterioration of stomach staples over time. In rare cases, digestive juices may enter the abdomen where they can cause infection and even death.

Gastric banding (often referred to as "Lap-Band" after the brand of band used in the procedure) uses a special band to create a small stomach pouch at the front of the stomach. This pouch remains attached to the rest of the stomach, but the hole between the two is so narrow that only small amounts of food may pass through at a time. Stomach stapling is sometimes used to help hold the band in place. The benefits and disadvantages of this type of surgery are very similar to the gastric bypass.

Resources

Davidson, T. (1999). Obesity surgery. Gale Encyclopedia of Medicine. Gale Research.

National Institute of Diabetes and Digestive and Kidney Diseases—Weight-Control Information Network. (2004, December). Gastrointestinal surgery for severe obesity [NIH Publication No. 04-4006].

Pories, W.J. (2002, March 1). The surgical treatment of obesity. Endotext.com.

Stanford Hospital & Clinics (Stanford, CA). (nd). Weight loss surgery.

West Shore Endoscopy Center (Camp Hill, PA). (nd). Gastric bypass diet.