Obesity is an epidemic in many developed countries. It has numerous consequences, both medically with multiple health problems and financially with the number of dollars in health care expenditures. Ongoing efforts to promote diet, exercise, and lifestyle modifications have varying degrees of success. However, there is still work to be done.
Options for treating obesity as a last resort include weight loss drugs and surgery. The latter is becoming more commonplace in hospitals. Weight loss surgery, or bariatric surgery, is no easy matter. There is much to know about what the surgery involves and what to expect afterwards.
Details of Procedures
Bariatric surgery comes in different procedures, all sharing the common goal of weight loss. They utilize restrictive and malabsorptive approaches. Restrictive procedures involve surgically reducing the size of the stomach to decrease the amount of food intake. Malabsorptive procedures involve reconnecting the stomach and intestines so that nutrients have less of an opportunity to be absorbed into the bloodstream.
There are two procedures that are purely restrictive.
- Adjustable Gastric Banding: A band is tightened around the stomach and secured with sutures to create a small gastric pouch above. This band is connected to an injection port placed under the skin. When salt solution, or saline, is injected through the port, the band is tightened further. If saline is withdrawn from the port, the band is loosened.
- Vertical Banding Gastroplasty: A hole is made in both the front and the back walls of the stomach. The edges of these holes are sewn to each other so that the stomach has a hole without the inside exposed. From there, the front and back walls of the stomach are stapled to each other vertically from this hole, creating a vertical staple line. Afterwards, a band is threaded through the hole so that it could be tightened around the stomach perpendicular to the staple line. The small gastric pouch is bounded by this band and the staple line. Vertical banding gastroplasty by itself is rarely performed today.
In addition, there are two procedures that are both restrictive and malabsoprtive.
- Roux-en-Y Gastric Bypass: A small gastric pouch is made with the top part of the stomach, just like with vertical banding gastroplasty. The middle part of the small intestine, the jejunum, is cut. The portion of intestine coming from the stomach is reconnected to the other part of the intestine further down from the original point. Meanwhile, the other intestinal portion is connected to the stomach pouch. This way, food goes from the small gastric pouch straight into the jejunum. Secretions from the liver and pancreas for further digestion come from the beginning of the small intestine, the duodenum, and meet up with the food later. By delaying the mixing of food and secretions, fewer calories are absorbed.
- Biliopancreatic Diversion: The lower part of the stomach is removed and the last part of the small intestine, the ileum, is cut. The intestine before the cut is reconnected to the ileum at a point further down while the intestine after the cut is connected to the stomach. Food goes straight from the stomach to the ileum while secretions from the liver and pancreas travel a longer distance through the duodenum and jejunum to the ileum.
Risks and Benefits
Many studies over the years have demonstrated that bariatric surgery results in significant weight loss and reduction of co-morbid conditions. However, there are some risks, including surgical complications and nutritional deficiencies. In addition, lifestyle changes are required. Patients still have to follow a strict diet after the surgery. Bariatric surgery is not a magic solution that works by itself. Success still requires compliance with instructions to keep the weight off and regular follow-up with a doctor in the long term.
Bariatric surgery is reserved for individuals whose obesity is severe with either a body mass index (BMI) of at least 40 kilograms per meters squared or at least 35 kilograms per meters squared in the presence of co-morbid conditions stemming from obesity. These patients must also have failed nonsurgical weight loss methods, understand the risks of surgery, and not be of high operative risk. Most importantly, eligible patients must be willing to actively manage their weight for life.
References
- National Institutes of Health (NIH)- Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults
- National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) - Gastrointestinal Surgery for Severe Obesity
