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Bariatric Surgery
An Option for Long-Term Weight Loss

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

A reduced quality of life is common among those who are obese. Things that people of normal weight do without much thought—such as bending over to tie their shoes, playing ball with a child, or sitting on the floor to read a book—are frequently done with great difficulty, or not at all, by people who are severely obese.

Weight loss has been shown to lower the risk of developing the medical conditions associated with obesity. Also, people often report an enhanced quality of life, mobility, and endurance after weight loss. But permanent weight loss is typically very hard to achieve. Anyone who has tried to lose weight knows that there is no shortage of programs, books, diets, and gimmicks that are supposed to help people lose weight. However, their success rate for long-term weight loss is very low. According to the National Institutes of Health, 90% of people who enroll in commercial weight-loss programs regain the lost weight within one year. Some people gain even more than they lost. Clearly, the odds are against losing weight and keeping it off long-term.

It is perhaps no surprise, then, that more and more people are turning to surgery to combat obesity.

Who is eligible?

To be considered for bariatric surgery you must meet at least one of the following criteria:

  • A body-mass index (BMI) of 40 or higher. For most people, this roughly correlates to being at least 100 pounds overweight.
  • A BMI of 35 or higher and at least one comorbidity, such as diabetes, heart disease, or sleep apnea.

(To check your approximate BMI, see this table).

In addition, you must understand the risks of surgery and be highly motivated to lose weight and stick to the restricted diet you will have after surgery.

Surgical procedures available
There are two main categories of weight loss surgery, restrictive and restrictive-malabsorptive.

Restrictive. These operations restrict food intake by reducing the size of the stomach to hold no more than 2 tablespoons, or 1 ounce, of food. Having a smaller stomach allows you to eat less and feel full with smaller portions. The stomach size eventually expands to hold about 8 tablespoons, or 1/2 cup, of food at a time.

In vertical banded gastroplasty (or stomach stapling), the upper stomach near the esophagus is stapled off vertically. A narrow band is placed at the outlet of the upper stomach to the lower stomach allowing food to move through slowly (click here for an illustration).

In adjustable gastric banding, an adjustable band is placed around the stomach, making a small pouch near the upper stomach (click here for an illustration).

Among the advantages of gastric banding is that it is reversible: The band can be removed. Both vertical banded gastroplasty and adjustable gastric banding restrict the amount of food eaten, and the narrow outlet allows food to stay in the small pouch longer, causing a feeling of fullness. Because the small intestine is not altered in either procedure, vitamin and mineral deficiencies are not a big concern, but it wouldn’t hurt to take a daily multivitamin since food intake is restricted.

Disadvantages include less overall weight loss than is seen with malabsorptive procedures. Long-term studies show that people generally maintain 40% to 60% of excess weight loss after vertical banded gastroplasty. In addition, the band or ring may cause an obstruction or perforation, making additional surgery necessary; gallstones may develop; or an infection can develop if stomach contents leak into the abdomen.

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