Obesity is an epidemic that affects an estimated one in three adults in the United States and is linked to many serious health conditions, such as Type 2 diabetes, heart disease and severe sleep apnea (when breathing stops for short periods during sleep).
It is a common thought that obesity is due to laziness or a lack of willpower, but this is simply not true. Obesity is a multi-factorial disease that can be caused by certain medical conditions and medicines, as well as by strong physiologic and biologic markers. For many people, it is just not as simple as “fewer calories and more exercise.”
A great deal of time and money are spent every year by Americans on diets, but only a small percentage of people are able to keep the weight off. Fortunately, for those that struggle with obesity and the health conditions associated with it, there is another option. Bariatric surgery has been shown to be very effective at producing significant and sustained weight-loss. There are several different weight-loss operations currently available that can lead to this desired result.
Adjustable Gastric Band (AGB): The AGB works mainly by decreasing food intake due to restriction. Food intake is reduced by placing a band with a silicone balloon around the top of the stomach, creating a small pouch. The amount of restriction can be tailored to the individual patient by adjusting the amount of fluid within in the balloon.
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Roux-en-Y Gastric Bypass (RYGB): RYGB also restricts food intake. However, unlike the adjustable gastric band, it also decreases how food is absorbed. A small pouch that is similar in size to the pouch created with the AGB limits food intake. This pouch is then connected directly to the small intestine, which affects how the digestive tract absorbs food. The food is absorbed differently because the majority of the stomach, duodenum and upper intestine no longer have direct contact with food.
Vertical Sleeve Gastrectomy (VSG): VSG also restricts food intake in that 70 to 80 percent of the stomach is removed. There is also a hormonal component with this surgery that may increase weight loss. With removing the upper part of the stomach, there is a decrease in ghrelin, which is a hormone that prompts appetite. Lower amounts of ghrelin may reduce hunger more than other purely restrictive surgeries and subsequently lead to more weight loss.
Currently, bariatric surgery is an option for adults with severe obesity. Body mass index, a measure of height in relation to weight, is used to define levels of obesity. Clinically severe obesity is a BMI greater than 40 or a BMI greater than 35 with a serious health problem linked to obesity, such as those listed above.
The Food and Drug Administration also has approved use of an adjustable gastric band for patients with a BMI greater than 30 who also have at least one condition linked to obesity.
Bariatric surgeons work with patients to help them decide which surgery is the best fit for them.
No matter what procedure a patient chooses, the key to bariatric surgery is getting the patient to use his or her weight-loss operation to implement lifestyle change. Each of the available surgeries truly is a tool, albeit an effective tool, that will help to control hunger and portion size, but that’s it. The rest is up to the patient.
Nicholas Brown is a general and bariatric surgeon with Wichita Surgical Specialists and Wesley Woodlawn Bariatric Surgery Center Medical Director.