Updated July 19, 2006

Bariatric Surgery
An Option for Long-Term Weight Loss

by Jacqueline Craig, M.S., R.D., C.D.E.

According to the Centers for Disease Control and Prevention, 175 million Americans, or nearly two-thirds of the adult population, are either overweight or obese. Of those who are obese, an estimated 5 million to 10 million are considered morbidly obese, meaning they are at least 100 pounds overweight. Because obesity is associated with some very serious health consequences, including early death, losing weight has long been recommended for obese adults. But many people find losing weight and keeping it off very difficult, if not impossible.

For obese people who have not been able to lose weight with diet, exercise, and possibly medication, bariatric surgery represents an option of last resort. Bariatric surgery reduces the size of the stomach, so that very little food can be eaten at one time, and some forms of the surgery also bypass part of the small intestine, so that fewer nutrients are absorbed. Bariatric surgery does not involve removing fat from the body through suction or excision.

Like any major surgery, bariatric surgery has risks and carries the possibility of complications. Even with no complications, it requires making major, lifelong changes in one’s eating habits to adapt to having a very small stomach. Some types of surgery also require taking vitamin and mineral supplements for life. While some people reach a normal weight following surgery, some do not, although they are less overweight than before.

In spite of the risks, drawbacks, and need to make significant lifestyle changes afterward, more and more people are having bariatric surgery. Currently, about 40,000 people annually have it done.

The trouble with obesity
Obesity is a growing problem not just in the United States but in many countries around the world. Multiple factors are playing a role in this increase in obesity. For one thing, there are fewer physically demanding jobs these days, so more people are sedentary in the workplace. Labor-saving devices such as cell phones, TV remote controls, and automobiles also cause people to be less active. Americans, particularly, are eating more meals in restaurants, which often serve larger portions than are needed to maintain a healthy weight.

However, carrying extra weight is not just about food and physical activity. Genetics, or a family history of weight problems, also play a role in body size.

Obesity raises the risk of many serious health conditions, including the following:

• Type 2 diabetes. Obesity is the main environmental risk factor for Type 2 diabetes. In fact, up to 80% of people with Type 2 diabetes are overweight or obese. Obesity is also associated with insulin resistance, which is one of the main causes of high blood sugar in Type 2 diabetes.
• High blood pressure, high cholesterol, and heart disease. Extra body weight puts a strain on the heart and blood circulation. High blood pressure and high blood cholesterol can increase the likelihood of strokes and heart attacks.
• Osteoarthritis. Excess weight on the joints can result in pain from increased wear and tear and inflammation.
• Sleep apnea. Fat can accumulate in the tongue and neck, causing a blockage of air into the lungs. The result is often disturbed sleep and daytime drowsiness. Sleep apnea can also make the heart work harder, resulting in high blood pressure.
• Cancer. Obesity is associated with an increased risk of endometrial, colon, gall bladder, prostate, and kidney cancer and breast cancer in women who have gone through menopause.

In addition to having a higher risk of many medical conditions, obese people often suffer psychologically and financially as well. Feelings of depression are very common among those who are morbidly obese. Such feelings may be caused or reinforced by repeated weight-loss failures; a disapproving attitude among family, friends, or coworkers; or experiences such as not fitting into the seats in public places such as the theater or ballpark. Research has shown that being obese lowers a person’s chances of being hired for a job or promoted. It has also shown that obese women’s wages tend to be lower than the wages of women of normal weight. (Obese men’s wages don’t appear to be lower than those of normal-weight men.)

Jacqueline Craig has worked in diabetes education for the past 13 years. Currently, she is a Registered Dietitian at an ADA-Recognized Diabetes Education Program, Group Health Associates, in Cincinnati, Ohio.

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