Surgery has become an acceptable method of treatment for clinically severe obesity because it appears to be the only option which can provide long-term maintained weight loss in-patients with clinically severe obesity. In fact, the number of patients having surgical treatment of obesity has doubled in recent years. Stomach, or gastric operations, have been preformed since 1969. Currently, the two leading approaches to weight-loss surgery in the United States are Roux-en-Y gastric bypass and adjustable gastric banding. Vertical banded gastroplasty, or stomach stapling, is less commonly performed today. Obesity surgeons should be skilled in more than one surgical approach as the specific procedure needs to be carefully matched to the individual patient.
How Surgery Causes Weight Loss
Procedures for weight loss are either restrictive and /or malabsorptive: they restrict the intake of food and/or cause some of the food to be poorly digested and absorbed, and therefore eliminated in the stool. Gastric banding, sleeve gastrectomy and vertical banded gastroplasty are "restrictive" surgeries, whereas the roux-en-y gastric bypass, banded gastric bypass and duodenal switch are "combination" type procedures resulting in both a restrictive and malabsorptive effect.
In surgery for obesity management your stomach is divided into two portions: the small portion is your new stomach, or reservoir for food. As you eat the food enters your pouch and empties slowly. Since your stomach pouch is very small, you will feel full very quickly. Overeating can be very uncomfortable and may result in vomiting. Your eating habits will therefore change drastically and you will likely never be able to eat the quantity of food that you can currently eat. For example, a typical size lunch for most patients is half a sandwich and a piece of fruit.
In addition, after gastric bypass surgery, most patients develop a phenomenon called "dumping syndrome". When sweets are eaten the patient experiences sweating, fatigue, lightheadedness and diarrhea. This unpleasant experience helps patients avoid sweets and many patients report losing their desire to indulge in sweets. Furthermore, eating large amounts of fats may lead to poor absorption and result in diarrhea and abdominal cramping.
Weight loss varies widely, depending on many factors, such as the patients age, starting weight, ability to exercise and the type of operation used. On average, patients lose one half to two thirds of their initial excess weight at the end of one year. Initially heavier patients tend to lose more actual pounds, but lighter patient are more likely to come close to their ideal weight. The average patient in our program loses 70% of their excess weight and over 95% of the patients lose at least half of their excess body weight with gastric bypass. Lap Band patients average 50% of their excess weight although 70% of excess weight-loss is possible depending on patients' motivation.
Surgery's Effect on Other Health Problems
The degree of improvement of various obesity-related problems depends on the extent of the illness and the length of time the patient has had it. The longer the patient has had the condition, the less likely it is for it to completely resolve after surgery. In general, more than half of the surgery patients find an improvement of their high blood pressure associated with diabetes. Nearly 80% of non-insulin dependent diabetes is controlled without medication after surgery. Obesity related respiratory problems, including sleep apnea and shortness of breath with minimal exercise, will become asymptomatic, improve or completely resolve. Joint and back pain associated with obesity, urinary incontinence, venous problems in the legs, acid reflux, menstrual irregularity, and certain types of headaches are also improved with weight loss after surgery.
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