Weight Loss Surgery

 How Weight Loss Surgery Reduces Weight?
Gastrointestinal surgery for obesity, also called bariatric surgery, alters the digestive process so as to achieve rapid weight loss. The operations can be divided into three types: restrictive, malabsorptive, and combined restrictive/malabsorptive. Restrictive weight loss surgeries limit food intake by creating a narrow passage from the upper part of the stomach into the larger lower part, reducing the amount of food the stomach can hold and slowing the passage of food through the stomach. Malabsorptive weight loss surgeries do not limit food intake, but instead exclude most of the small intestine from the digestive tract so fewer calories and nutrients are absorbed. Malabsorptive weight loss surgeries, also called intestinal bypasses, are no longer recommended because they result in severe nutritional deficiencies. Combined operations use stomach restriction and a partial bypass of the small intestine.

 Am I a Candidate for Weight Loss Surgery?
You may be a candidate for weight loss surgery if you have:

1. a body mass index (BMI) of 40 or more about 100 pounds overweight for men and 80 pounds for women (see BMI chart)
2. a BMI between 35 and 39.9 and a serious obesity-related health problem such as type 2 diabetes, heart disease, or severe sleep apnea (when breathing stops for short periods during sleep)
3. an understanding of the operation and the lifestyle changes you will need to make.

 Is Weight Loss Surgery for You?
Bariatric weight loss surgery may be the next step for people who remain severely obese after trying nonsurgical approaches, or for people who have an obesity-related disease. Surgery to produce quick weight loss is a serious undertaking. Anyone thinking about undergoing this type of weight loss surgery should understand what it involves. Answers to the following questions may help you decide whether weight loss surgery is right for you.

Are you:
    * unlikely to lose weight or keep weight off long-term with nonsurgical measures?
    * well informed about the surgical procedure and the effects of the weight loss surgery?
    * determined to lose weight and improve your health?
    * aware of how your life may change after the operation (adjustment to the side effects of the operation, including the need to chew food well and inability to eat large meals)?
    * aware of the potential for serious complications, dietary restrictions, and occasional failures related to weight loss surgery?
    * committed to lifelong medical follow-up and vitamin/mineral supplementation?
Remember: There are no guarantees for any method, including surgery, to produce rapid weight loss and maintain it. Success with weight loss surgery is possible only with maximum cooperation and commitment to behavioral change and medical follow-up and this cooperation and commitment must be carried out for the rest of your life.
A decision to have bariatric surgery is very personal and very important. It will change your life in an irreversible way for the most part, not just because of the quick weight loss it produces. Being careful with a decision like this is the right thing to do. You should research the various weight loss surgeries and the various surgeons. Then you and the surgeon should, together, agree that weight loss surgery is the best choice you can make.
Considerations prior to weight loss surgery:
    * Can you comply with the therapy and follow up that is so necessary after weight loss surgery?
      You have to follow the directions of your surgeon, especially diet, exercise, labs and office follow up. The surgery is a tool only. Rapid weight loss and maintenance depends on your use of this tool. It would be disastrous if one depends on the surgery alone to take care of the obesity. There will never be a break in following the guidelines set forth by your surgeon regarding diet, exercise and follow up. You are making a life-long commitment.
   * Are you considering weight loss surgery for the right reasons? Do you just want to look better?
      Bariatric surgery is NOT done for cosmetic reasons. It is always done to improve failing health. If you meet the medical criteria, you are considering weight loss surgery for health reasons. Feeling better is the goal, looking better is a nice side effect.
    * Have you made many attempts at weight loss?
      Only you can decide if you have reached the point where you have exhausted all other options to lose weight. You are making a serious decision that only YOU can make, once you feel you are well informed about the risks and benefits of weight loss surgery.
    * Are you comfortable with your decision? Are you apprehensive?
      Once you are feeling comfortable with your decision to make a lifestyle change forever and you know you can do it, you are ready. If you know exactly and feel comfortable with how the weight loss surgery rearranges your digestive system and the short and long-term risks of bariatric surgery, you are ready. If you have found a surgeon that you feel very comfortable with, you are ready. If you are apprehensive about the whole process, you are normal!
 Types of Weight Loss Surgeries
There are several types of restrictive and combined operations that lead to rapid weight loss. Each one has its own benefits and risks.

Restrictive Weight Loss Surgeries

Purely restrictive operations only limit food intake and do not interfere with the normal digestive process. To perform the operation, doctors create a small pouch at the top of the stomach where food enters from the esophagus. At first, the pouch holds about 1 ounce of food and later may stretch to 2-3 ounces. The lower outlet of the pouch is usually about ¾ inch in diameter or smaller. This small outlet delays the emptying of food from the pouch into the larger part of the stomach and causes a feeling of fullness, thus resulting in rapid weight loss in most patients.

After the operation, patients can no longer eat large amounts of food at one time. Most patients can eat about ¾ to 1 cup of food without discomfort or nausea, but the food has to be soft, moist, and well chewed. Patients who undergo restrictive procedures generally are not able to eat as much as those who have combined operations.
 1. Adjustable Gastric Banding (also known as the LAP-BAND) In this procedure, a hollow band made of silicone rubber is placed around the stomach near its upper end, creating a small pouch and a narrow passage into the rest of the stomach. The band is then inflated with a salt solution through a tube that connects the band to an access port placed under the skin. It can be tightened or loosened over time to change the size of the passage by increasing or decreasing the amount of salt solution.