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The basics of bariatric surgery.
The following is the first of a two-part article about bariatricsurgery. This information is for educational purposes and does not replace consultation with a physician.
With surging rates of obesity, and its associated health problems, in America and around the globe, the search for a solution continues. One such possibility is bariatricsurgery, more commonly known as gastric bypass surger y or stomach stapling. This technique has been gaining popularity recently, as celebrities (Randy Jackson of American Idol; Al Roker of Today; and Carnie Wilson, daughter of Beach Boy Brian Wilson) are becoming poster boys and girls for the procedure. Although the results of bariatric surgery are touted regularly by the media, many who are considering this option don't understand the mechanics of the procedure or how it can cause such dramatic weight loss.
What is BariatricSurgery?
Essentially, bariatricsurgery changes the anatomy and physiology of the digestive system which results in a reduction in the amount of food it can accommodate and/or the amount of calories and nutrients it can absorb.
The two basic types of bariatricsurgery:
1. Restrictive procedures effect weight loss by reducing the volume of food the stomach is capable of accommodating; they do not alter the digestive process. By partially closing the upper part of the stomach with an adjustable band and/or staples, the surgeon creates a small pouch. Food exits the pouch through an opening into the lower stomach, which is deliberately made small to delay emptying.
The two restrictive procedures are:
- Adjustable gastric banding (AGB)
- Vertical banded gastroplasty (VGB)
Although weight loss is achieved with restrictive procedures, they are not as successful as malabsorptive procedures. Not only do some patients regain lost weight, those patients who do not adjust their dietary lifestyle, may not lose any weight.
2. Malabsorptive procedures effect weight loss by altering the size of the stomach and reducing the amount of absorption in the digestive system. A small pouch is created using the upper stomach, which is then connected directly to the lower portion of the small intestine. The surgeon bypasses the lower stomach, duodenum, and most or all of the jejunum. The small intestine is the region of highest caloric and nutrient absorption.
The two malabsorptive procedures are:
- Roux-n Y (RGB)
- Biliopancreatic diversion (BPD)
Malabsorptive procedures result in greater weight loss than restrictive procedures, and, perhaps more importantly, they are more effective in reversing the health problems associated with excessive weight. Currently, the Roux-n Y (RGB) is the most common procedure, and it is now being performed laparoscopically, which means smaller incisions, less pain and scarring, and quicker recovery time.
How Much Weight do Patients Lose?
Patients who undergo malabsorptive procedures, such as RGB, can expect to lose approximately two-thirds of their excess weight (about 100 pounds) within the first two years following surgery, and most people are able to maintain this loss in the long term. Gradually, as the patient's metabolic needs decrease (as a result of weight loss) and caloric absorption increases (as a result of the digestive system adapting and the pouch expanding to accommodate more food), the rate of weight loss reduces.
In Addition to Weight Loss, What are the Benefits of Surgery?
Health benefits:
Reduced mortality rates
Improvement of most obesity-related conditions, e.g., severe sleep apnea
Normalization of high blood pressure
Improved control, or normalization, of blood sugar in those suffering from type II diabetes
Social benefits:
Increased self-esteem
Improved socialization
Improved marital relations (but only if the relationship was harmonious prior to surgery)
Who Qualifies for Bariatric Surgery?
To qualify for bariatricsurgery, a candidate must:
Have a BMI greater than 40 (approximately 100 excess pounds).
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Height/Weight examples
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BMI
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height
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weight
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40
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6'0"
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300 pounds
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40
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5'6"
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250 pounds
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40
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5'0"
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205 pounds
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OR
Have a BMI greater than 35 and be at high-risk for obesity-related conditions, such as diabetes, cardiovascular disease, severe sleep apnea, and Type 2 diabetes.
Other factors to consider:
Is the candidate unable to lose weight using traditional methods of dietary and behavioral changes?
Is the candidate suffering from health complications due to their obesity?
Is the candidate's obesity compromising their quality of life? In women, failure to conceive is a positive indication for bariatric surgery.
Some candidates may be required to lose weight prior to surgery because of the limitations of endoscopic equipment and operating tables.
Candidates who meet the requirements are then assessed physically and psychologically.
How are Candidates Assessed for BariatricSurgery?
Ideally, a multidisciplinary team consisting of a physician, dietician, and psychologist/psychiatrist will assess the candidate. There are two main areas of evaluation:
1. The physical Evaluation assesses the presence and status of obesity-related health conditions, as well as whether these conditions could complicate either the surgery or the recovery.
2. Generally, the psychological evaluation is used to predict whether the candidate's bariatric surgery will be successful.
Does the candidate have an undiagnosed psychological condition (e.g., an eating disorder)?
Is the candidate motivated to lose weight?
Is the candidate knowledgeable of the procedure, the associated risks, and possibility of failure?
Does the candidate understand the need for life-long dietary and behavioral changes?
What is the candidate's possible response to weight loss and change in body image? For example, if a candidate suffers from depression prior to surgery, weight loss alone may not alleviate the feelings of depression.
What factors contributed to the success or failure of previous weight loss attempts?
Does the candidate have a social support system?
See Part 2
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