Surgery for Weight Loss
It's a radical way to lose weight, but each year thousands of obese people are resorting to it. Surgery is a last resort, but it is also the only proven way to achieve long-term weight control for the severely obese, according to the American Society for Bariatric Surgeons (ASBS), which represents board-certified surgeons who treat seriously obese patients. Obesity surgery is not a cosmetic procedure. It is not liposuction, which involves surgical suctioning out body fat. About 15 million Americans today are obese, with 6 million of those being morbidly obese, or have a BMI of more than 40. The American Society for Bariatric Surgeons estimates that its 400 members perform about 100 obesity operations a year. That total, 40,000, is considered conservative, however, because other surgeons beside ASBS members perform obesity surgery. Who is a candidate? Being 10 pounds overweight does not make someone a candidate for obesity surgery, but being 100 pounds overweight does. Surgeons essentially use a person's Body Mass Index (calculated based using height and weight) as a guide. A BMI of 40 or above - that's being overweight by 100 pounds for men and about 80 pounds for women - indicates that a person is severely obese and therefore a candidate for surgery, according to federal guidelines. A person who is 5 feet, 6 inches and weighs 248 pounds, for example, has a BMI of 40. People with lower BMIs of between 35 and 40 also may be candidates if they have medical conditions that are adversely affected by obesity, such as diabetes, heart failure, obstructive sleep apnea and degenerative osteoarthritis. Obesity puts people at risk for a host of medical problems, including coronary artery disease, diabetes and high blood pressure. Even if a patient meets the weight criterion for surgery, medical experts in the field say he or she should first be considered for treatment in a nonsurgical program, which involves a dietary regimen, exercise, behavioral modification and support. A National Institutes of Health panel of gastroenterologists, endocrinologists and other health experts recently addressed obesity surgery. They suggested patients who are candidates for the surgery should make sure that the operation is performed by a surgeon substantially experienced with appropriate procedures and working in a clinical setting with adequate support. Popular surgeries and their risks A number of obesity operations are no longer practiced because of complications. Intestinal bypass, at one time, was the most commonly performed procedure. Today it is rarely done because of complications (some studies showed a 10 percent death rate). Two procedures dominate practice today and, although there are still risks - as with any surgical procedure - the benefits appear to outweigh those risks, according to the American Obesity Association. The biggest benefit: that patients after obesity surgery lose 48 percent to 74 percent of their excess weight in the first year after surgery if they follow diet and behavior recommendations. The rate of weight loss slows over time, however, and eventually the patient's weight stabilizes. Most surgery to treat severe obesity surgically involves restriction of the stomach size. There are a number of gastric restriction procedures available, many newer, easier to perform and less invasive than stomach stapling. The most frequently performed procedure is called Vertical Banded Gastroplasty. In VBG, restrictive bands or staples are used to create a small pouch in the stomach and a small outlet is constructed at the bottom of the pouch, according to the ASBS. The pouch only holds one-half to two ounces of food. The second most frequently performed surgery for obesity is a malabsorptive procedure called a Roux-en-Y gastric bypass (RGB), which connects the top of the stomach to the intestine bypassing the bottom of the stomach and the beginning of the intestine. The longer the section of intestine bypassed, the greater the malabsorption and the greater the weight loss. Over the last several years surgeons have been combining both restrictive and malabsorptive procedures in the same patient. This has resulted in a long-term weight loss of close to 100 pounds for the average patient. Patients may suffer complications as a result of surgery. It is best to ask for specifics from the operating surgeon and from the hospital where the surgery is to be performed. Risks will vary depending upon the operation chosen as well. Some centers are recognized nationwide for specializing in bariatric surgery, and it is important to discuss these issues. Risks include wound infections, leaks or tears around the stomach bands, ulcers, breathing problems and blood clots. After obesity surgery, you must remain under medical supervision for the rest of your life. Sources: American Obesity Association American Society for Bariatric Surgery The National Institutes of Health
This article was reviewed and updated June 2007.
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