Health & Fitness

Doc Talk: Weigh risks, benefits before bariatric surgery

As America continues its battle of the bulge — with more than one-third of the population suffering from obesity — more and more people are turning to the weight-loss solution of bariatric surgery.

Candidates for bariatric surgery are adults who are 100 pounds or more over their ideal body weight, have a body mass index (the relationship of weight and body fat to height) of 40 or more, or a BMI of 35 or higher in combination with another health-related condition, such as type 2 diabetes, hypertension or heart disease.

The decision to have weight-loss surgery is a monumental one. However, when compared with other weight-loss methods such as dieting, surgery is the only way to get consistent, permanent weight loss for obese individuals, according to the National Institutes of Health.

Even the popular Dr. Oz says it’s an underutilized surgery, not only because of its effects on a person’s waistline but because patients often see a resolution or improvement in other health conditions such as type 2 diabetes, high blood pressure, high cholesterol and even sleep apnea.

In a recent article in the Journal of the American Medical Association, bariatric surgery also was associated with a reduction in the number of cardiovascular deaths and a lower incidence of cardiovascular events.

Bariatric surgery is an expensive option, ranging between $10,000 to $26,000, depending on the type of surgery. However, a recent study showed that bariatric surgery pays for itself in about two years. The reason: By reducing or improving other health conditions, patients often save money on related prescription drugs, doctor visits and hospital visits.

Bariatric patients also report being in much better health overall and having a much better quality of life because they increase their social interactions, physical activities and other aspects of their life. It’s what we call non-scale life improvements.

But before delving further into bariatric surgery, let’s take a look at the normal digestive process. The stomach typically holds just more than 3 pints of food from a single meal. In this organ, food is mixed with digestive acids and juices to help break down complex proteins, fats and carbohydrates. When the food is digested, the stomach contents are dumped into the first portion of the small intestine, the duodenum, where most of the absorption of nutrients happens. The small intestine is about 15 to 20 feet long and has three parts: the duodenum, the jejunum and the ileum.

There are three primary types of bariatric surgeries, each of which has advantages and risks. The decision regarding which procedure is done is determined by the bariatric surgeon and patient together.

All three procedures involve creating a smaller stomach pouch in order to limit the amount of food that can be eaten. This is known as a restrictive procedure. A gastric bypass surgery also alters the digestive process, causing food to be poorly digested and incompletely absorbed. This is called a malabsorptive procedure.

In a bariatric surgery, the surgeon can either tie off a part of the stomach (gastric banding), make it smaller — about the size of a banana — and remove the rest of it (gastric sleeve), or reroute the process (gastric bypass).

As far as weight-loss effectiveness, the band provides about 43 percent total of excess body weight loss and is considered reversible. The sleeve gastrectomy provides an average of 55 percent total excess body weight loss. The gastric bypass provides 62 percent total excess body weight loss.

Gastric bypass, which combines the restrictive and malabsorptive techniques, is the most frequently performed surgery. The stomach is stapled to create a very small pouch that will hold little more than one tablespoon of food, and the small intestine is divided and connected to the small pouch, bypassing the duodenum.

If you are considering bariatric surgery, it’s important that you recognize that surgical weight loss is not a magic bullet to solve weight issues. The best surgical weight-loss programs will include evaluations and education to help you understand how surgery will affect your lifestyle and food and dietary intake. You’ll also want to check into outcomes, such as the number of deaths and statistical improvement or resolution of other health conditions, of any program you’re considering.

Most of the time, by the time a patient has decided bariatric surgery is an option, they just want to have it done. But one needs to take the time to understand the risks, the benefits and the behavior modification needed. A well-educated patient will have a far more successful outcome.

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