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- Patient Comments: Obesity - Effective Treatments
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- Obesity facts
- What is obesity?
- How common is obesity?
- What are the health risks associated with obesity?
- What causes obesity?
- What are other factors associated with obesity?
- How is body fat measured?
- What about weight-for-height tables?
- What is the body mass index (BMI)?
- Does it matter where body fat is located? (Is it worse to be an "apple" or a "pear"?)
- What can be done about obesity?
- What is the role of physical activity and exercise in obesity?
- What is the role of diet in the treatment of obesity?
- What is the role of medication in the treatment of obesity?
- What about herbal fen/phen?
- What about meal substitutes, artificial sweeteners, and over-the-counter (OTC) products?
- What is the role of surgery in the treatment of obesity?
- How can patients choose a safe and successful weight-loss program?
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What is the role of surgery in the treatment of obesity?
The National Institute of Health consensus has suggested the following guidelines for surgery in obese patients:
- Patients with a BMI of greater than 40
- Patients with a BMI of greater than 35 who have serious medical problems such as sleep apnea that would improve with weight loss
A study done in Sweden compared the rates of diabetes and hypertension in two groups of obese patients: those who underwent surgery and those who didn't. Each group had similar body weight at baseline (the start of the study). At two years, diabetes and high blood pressure were lower in the patients treated with surgery.
Surgical procedures of the upper gastrointestinal tract are collectively called bariatric surgery. The initial surgeries performed were the jejunocolic bypass and the jejunoileal bypass (where the small bowel is diverted to the large bowel, bypassing a lot of the surface area where food would have been absorbed). These procedures were fraught with problems and are no longer performed. Currently, procedures used include making the stomach area smaller or bypassing the stomach completely.
Currently, there are basically two types of bariatric surgery:
Restrictive surgeries: These surgeries restrict the size of the stomach and slow down digestion.
Malabsorptive/restrictive surgeries: These surgeries restrict the size of the stomach but also bypass or remove part of your digestive system to decrease absorption of food/calories.
In the cases of making the stomach smaller, vertically banded gastroplasty is the most common procedure, where the esophagus is banded early in the stomach. The other procedure is gastric banding, where an inflatable pouch causes gastric constriction. Changing the volume in the ring that encircles the stomach can change the amount of constriction. Gastric bypass essentially causes weight loss by bypassing the stomach.
The most common malabsorptive surgery is the Roux-en-Y gastric bypass, in which the stomach is stapled to create a small pouch, and then part of the intestine is attached to this pouch to decrease food absorption.
The surgical treatment of obesity and the surgical procedures are evolving constantly and frequently are done by laparoscopic methods (using tiny incisions and a camera to carry out the surgery). Although these procedures are becoming more routine, the mortality rate for these procedures is still between 0.5%-2% with a significant incidence of complications.
The risks of surgery include the usual complications of infection, blood clots in the lower extremities (deep vein thrombosis) and in the lungs (pulmonary embolism), and anesthesia risk. Specific long-term risks related to obesity surgery include lack of iron absorption and iron deficiency anemia. Vitamin B12 deficiency can also develop and could lead to nerve damage (neuropathies). Rapid weight loss may also be associated with gallstones. Bariatric surgery should be performed at a center with a whole weight-loss program in place that includes dieticians and therapists and follow-up care.