Severe obesity is a chronic condition that is very difficult to treat. For some people, weight loss surgery helps by restricting food intake or interrupting digestive processes. But keep in mind that weight loss surgery is a serious undertaking. You should clearly understand the pros and cons associated with the procedures before making a decision.
In order to understand how weight loss works, you need to first understand how the normal digestive process functions.
Normally, as food moves along the digestive tract, appropriate digestive juices and enzymes arrive at the right place and at the right time to digest and absorb calories and nutrients. After we chew and swallow our food, it moves down the esophagus to the stomach, where a strong acid continues the digestive process. The stomach can hold about 3 pints of food at one time. When the stomach contents move to the duodenum, the first segment of the small intestine, bile and pancreatic juices speed up digestion. Most of the iron and calcium in the foods we eat is absorbed in the duodenum. The jejunum and ileum, the remaining two segments of the nearly 20 feet of small intestine, complete the absorption of almost all calories and nutrients. The food particles that cannot be digested in the small intestine are stored in the large intestine (made up of the ascending colon, transverse colon, descending colon, sigmoid colon and rectum) until eliminated.
Obesity surgery involves making changes to the stomach and/or small intestine.
How Does Weight Loss Surgery Work?
The concept of gastric surgery to control obesity grew out of results of operations for cancer or severe ulcers that removed large portions of the stomach or small intestine.
Because patients undergoing these procedures tended to lose weight after surgery, some doctors began to use such operations to treat severe obesity. The first operation that was widely used for severe obesity was a type of intestinal bypass. This operation, first used 40 years ago, caused weight loss through malabsorption (decreased ability to absorb nutrients from food because the intestines were removed or bypassed).
The idea was that patients could eat large amounts of food, which would be poorly digested or passed along too fast for the body to absorb many calories. The problem with this surgery was that it caused a loss of essential nutrients (malnutrition) and its side effects were unpredictable and sometimes fatal. The original form of the intestinal bypass operation is no longer used.
Surgeons now use other techniques that produce weight loss primarily by limiting how much the stomach can hold. Two types of surgical procedures used to promote weight loss are:
Restrictive surgery: During these procedures the stomach is made smaller. A section of your stomach is removed or closed which limits the amount of food it can hold and causes you to feel full.
Malabsorptive surgery: Most of digestion and absorption takes place in the small intestine. Surgery to this area shortens the length of the small intestine and/or changes where it connects to the stomach, limiting the amount of food that is completely digested or absorbed (causing malabsorption). These surgeries are now performed along with restrictive surgery.
Through food intake restriction, malabsorption, or a combination of both, you can lose weight since less food either goes into your stomach or stays in your small intestine long enough to be digested and absorbed.
Vertical banded gastroplasty (VBG). Surgical staples are used to divide the stomach into two parts. The upper part is small, which limits space for food. Food empties from the upper pouch into the lower pouch through a small opening. A band is put around this opening so it doesn’t stretch. Risks of Vertical banded gastroplasty include wearing away of the band and breakdown of the staple line. In a small number of cases, stomach juices may leak into the abdomen or infection or death from complications may occur.
Laparoscopic gastric banding (Lap-Band). An inflatable band is placed around the upper stomach to create a small pouch and narrow passage into the remainder of the stomach. This limits food consumption and creates an earlier feeling of fullness. Once the band is in place, it is inflated with saline. The band is adjusted over time by increasing or decreasing the amount of salt solution to change the size of the passage. The band is intended for severely obese people — those at least 100 pounds overweight or who are at least twice their ideal body weight — who have failed to lose weight by other methods such as a supervised diet and exercise. The band is intended to remain in place permanently, but it can be removed if necessary. People who get the band will need to diet and exercise in order to maintain their weight loss. Complications may include nausea and vomiting, heartburn, abdominal pain, band slippage, or pouch enlargement.
Roux-en-Y gastric bypass (RGB). The surgeon makes the stomach smaller by using surgical staples to create a small stomach pouch. The pouch is attached to the middle part of a small intestine. Food bypasses the upper part of the small intestine and stomach and goes into the middle part of the small intestine through a small opening. Bypassing the stomach limits the amount of food a person can eat. By bypassing part of the intestine, the amount of calories and nutrients the body absorbs is reduced. The small opening slows down the rate food leaves the pouch. One risk for patients is “dumping syndrome.” This happens when the stomach contents move too rapidly through the small intestine. Symptoms may include nausea, weakness, sweating, faintness, and diarrhea after eating. Side effects include infection, leaking, pulmonary embolism (sudden blockage in a lung artery), gallstones, and nutritional deficiency.
Biliopancreatic diversion (BPD). This procedure is not commonly used in the United States. A large part of the stomach is removed. The amount of food is restricted, in addition to stomach acid production. The small pouch that remains is connected directly to the final segment of the small intestine, completely bypassing other parts of the small intestine. A common channel remains in which bile and pancreatic digestive juices mix prior to entering the colon. Weight loss occurs since most of the calories and nutrients are routed into the colon where they are not absorbed. This procedure is less frequently used than other types of surgery because of the high risk for nutritional deficiencies. A variation of BPD includes a “duodenal switch,” which leaves a larger portion of the stomach intact, including the pyloric valve that regulates the release of stomach contents into the small intestine. It also keeps a small part of the duodenum.
Benefits and Risks of Weight Loss Surgery
Weight loss surgery is a serious undertaking. Before making a decision, talk to your doctor about the following benefits and risks.
Weight loss: Immediately following surgery, most patients lose weight rapidly and continue to do so until 18 to 24 months after the procedure. Although most patients then start to regain some of their lost weight, few regain it all.
Obesity-related conditions improve: For example, in one study, blood sugar levels of most obese patients with diabetes returned to normal after surgery. Nearly all patients whose blood sugar levels did not return to normal were older or had diabetes for a long time.
Risks and Side Effects
Vomiting: This is a common risk of restrictive surgery caused by the small stomach being overly stretched by food particles that have not been chewed well.
“Dumping syndrome:” Caused by malabsorptive surgery, this is when stomach contents move too rapidly through the small intestine. Symptoms include nausea, weakness, sweating, faintness and, occasionally, diarrhea after eating, as well as the inability to eat sweets without becoming extremely weak.
Nutritional deficiencies: Patients who have weight-loss surgery may develop nutritional deficiencies such as anemia, osteoporosis, and metabolic bone disease. These deficiencies can be avoided if vitamin and mineral intakes are maintained.
Complications: Some patients who have weight-loss operations require follow-up operations to correct complications. Complications can include abdominal hernias, infections, breakdown of the staple line (used to make the stomach smaller), and stretched stomach outlets (when the stomach returns to its normal size).
Gallstones: More than one-third of obese patients who have gastric surgery develop gallstones. Gallstones are clumps of cholesterol and other matter that form in the gallbladder. During rapid or substantial weight loss a person’s risk of developing gallstones increases. They can be prevented with supplemental bile salts taken for the first six months after surgery.
Need to temporarily avoid pregnancy: Women of childbearing age should avoid pregnancy until their weight becomes stable because rapid weight loss and nutritional deficiencies can harm a developing fetus.
Side effects: These include nausea, vomiting, bloating, diarrhea, excessive sweating, increased gas and dizziness.
Lifestyle changes: Patients with extensive bypasses of the normal digestive process require not only close monitoring, but also life-long diet and exercise modifications and vitamin and mineral supplementation.
Am I a Candidate Weight Loss Surgery?
If you have a body mass index (BMI) of 40 or more — which is about 100 pounds overweight for men and about 80 pounds for women — you are considered severely obese and therefore a candidate for weight loss surgery.
Obesity surgery may also be an option for people with a BMI between 35 and 40 who suffer from obesity-related problems (for example, severe sleep apnea, obesity-related heart disease, or diabetes). For these people, the risk of death from not having the surgery may be greater than the risks from the possible complications from undergoing the procedures.
Keep in mind that as in other treatments for obesity, results may vary. In many cases, patients are required to show proof that their attempts at dietary weight loss have been ineffective before surgery will be approved. A psychological evaluation may be required by doctors to determine your potential response to weight loss and change in body image. Most surgeons require patients to demonstrate serious motivation and a clear understanding of the extensive dietary, exercise, and medical guidelines that must be followed for the remainder of their lives after having weight loss surgery. In addition, studies are performed to assess the health of your heart and hormonal systems. Nutritional counseling is also a must before and after surgery.
For patients who remain severely obese after non-surgical approaches to weight loss have failed, or for patients who have an obesity-related disease, surgery may be an appropriate treatment option. But for most patients, greater efforts toward weight control, such as changes in eating habits, lifestyle changes, and increasing physical activity, are more appropriate. The following questions may help you decide if weight loss surgery is right for you.
Have you tried to lose weight through conventional methods of weight loss: group classes, one-on-one counseling, calorie controlled meal plans, food journals, and exercise?
Are you well informed about the surgical procedure and the effects of treatment?
Are you determined to lose weight and improve your health?
Are you aware of how your life may change after the operation (adjustment to the side effects of the surgery, including dramatically different eating habits)?
Are you aware of the potential for serious complications from the procedure, the associated dietary restrictions, and the slight chance that the procedure will not help you lose weight?
Are you committed to life-long medical follow-up?
10 Ways to Sabotage Weight Loss Efforts
“Gimme a super size fry……Two big macs…..that 20 piece nuggets…….oh and a DIET coke. I’m on a diet.” Duh. Here are ten don’ts that are counter productive to losing weight.
10. Skip Breakfast. This may sound like a strange way to gain fat, but if you skip meals (especially breakfast) your body can think it’s starving. When your body goes into starvation mode, it becomes extra proficient at storing calories as fat. A good way to take advantage of this would be to go 10-12 hours without eating, like by skipping breakfast, and then gorge yourself with as big a lunch as you can. This way your body will be saving every little calorie you give it.
9. Sleep less. This is a trick which works for a number of reasons. Sleeping less will give your body less rest which will increase your stress throughout the day. Stress is not only a great motivator for eating, but it also increases levels of certain hormones that trigger weight gain. Another reason that sleeping less is great is that now you’ll have more time to eat! For an extra pound or two, try gorging yourself with high calorie foods right before bed. These calories are more likely to be stored as fat!
8. Lower vegetable intake. Vegetables are simply empty vitamins. They have very little, if any, caloric content. Vegetables will fill you up so you won’t be able to cram in the better, more fattening choices. Some vegetables contain less calories than it takes to digest them so you actually wind up burning calories while eating! Avoid them at all costs.
7. Snack constantly. Who says that there are only 3 meal times in a day? Five or six meals a day are much better. However, if you can’t get away 6 times a day for a meal, try munching on candy bars and sodas while you wait. A good rule of thumb is to always have some food in or on its way to your mouth.
6. Increase your meal portions. You simply aren’t going to get fat eating small girly portions of food. A surefire way to pack on the pounds is to eat double of whatever you think you need. If you need help in this area, try ordering anything in a restaurant. It’s almost certain that they will provide you with more than one serving of everything. Also, always remember to ’supersize it’ any time you can. The average person can usually process about 700 calories per meal. Anything over that gets stored as fat almost immediately. That’s just what you need to get your body to super-sized proportions quickly.
5. Eat fried foods. French fries, fried chicken, fried onion rings, etc. are all good. When something is fried, it is literally soaked in oil which means lots of saturated fats. Saturated fats are not only great for gaining weight, but they are also great at giving you all kinds of health problems – particularly with your heart. If you can up your daily intake of fried potatoes, then you’ll definitely have no trouble upping your weight.
4. Stop drinking water. Like the veggies, water just takes up precious space in the real estate of your gut. If you really want to get as fat as possible, you should stop drinking water all together. Some even speculate that drinking water can cause you to lose weight in and of itself. If there’s no Coke around, reach for a sweet tea. If there’s no sweet tea, reach for the maple syrup. Water must be avoided at all costs!
3. Eat fast food more often. Fast food restaurants are like the embassies of weight gain. These places not only serve the most fattening foods, they also genuinely want to help you in your commitment to put on fat. They provide cheap, fast, and extraordinarily fattening additions to the weight gain diet. Would you like fries with that? Heck Yes! How about a 64oz soft drink with your 1,000 calorie meal? Brilliant!
2. Drink lots of soft drinks. Seriously, this is one of the best ways to pack on the pounds. Coke, Pepsi and all other forms of soft drinks are loaded with high fructose corn syrup. This substance is chemically altered to be sweet and cheap. However, it is also toxic to your body. It actually blocks certain receptors in your brain that tell you when you’re full, so you just keep eating and drinking. Plus, the caffeine in these drinks makes them highly addictive.
1. Never, Ever Exercise. Come on people, this one should be fairly obvious. To get fat, you need to store calories. Exercise, however, burns calories. This is simply counterproductive to the fat plan. If you can, I recommend driving everywhere, even if it’s within walking distance. Also, opt for the elevator instead of the stairs. Lastly, if you can, I’d encourage at least 4-5 hours of idle tv watching a night. This is a great way to save on spending any extra calories.