Weighing the facts on weight loss surgery for Americans

By Jeffrey Hunter, MD and

Katherine Redmon, PA-C

For The Mirror

The rise of severe obesity in Americans has created an escalating demand for weight loss surgery.

In the past decade alone, the number of these procedures has increased more than 600 percent.

For people who are twice their normal weight or greater than 100 pounds over their ideal body weight, the risk of health problems such as diabetes, high blood pressure, heart disease and sleep apnea is dangerously high.

Weight loss surgery can be an effective treatment for morbid obesity and related diseases, but its success requires a thorough understanding of the procedure, its risks and life-long impact to the patient.

When weight loss surgeries debuted in the 1950s, they consisted of intestinal bypasses, which often produced severe, sometimes life-threatening complications. Because so much of the digestive process was bypassed in these procedures, many patients suffered serious nutritional deficiencies and even liver damage.

Restrictive weight loss surgeries, which worked by reducing the amount of food the stomach could hold (as in stomach “stapling”) were also introduced, but were prone to failing over time.

Restrictive procedures using bands (or bands and staples) are still available today, but continue to have higher failure rates and result in less weight loss than surgeries that also bypass some of the digestive process.

Procedures that combined both the restriction of food intake and the absorption of food were introduced in the late 1960s.

The most common of these gastric bypass procedures, called the Roux-en-Y (pronounced “roo-on-why”) curbed the incidence of severe malnutrition while providing effective weight loss.

Over the years, the Roux-en-Y has undergone a number of refinements to become the “gold standard” for gastric bypass surgery.

In a Roux-en-Y gastric bypass, the surgeon creates a small, golf ball-sized stomach pouch to restrict food intake.

The smaller stomach will cause the patient to feel full much more quickly, effectively controlling hunger.

Next, a Y-shaped section of the small intestine is attached to the pouch to allow food to bypass the first 100 to 150 centimeters of the small intestine, reducing the amount of calories absorbed from food.

The bypassed portion of the intestine is left in place to supply bile from the liver, stomach acid and pancreatic juices to aid digestion after the procedure.

The combination of decreased absorption of calories and controlling appetite helps most patients lose weight quickly and maintain their new weight.

Patients typically lose 60 to 80 percent of their excess body weight, and recent studies have shown that 85 to 95 percent of Roux-en-Y gastric bypass patients have maintained their weight loss five years after surgery.

A recent innovation in gastric bypass surgery is the use of minimally invasive surgical techniques.

Procedures including the Roux-en-Y can be done laparoscopically, allowing the surgeon to make small incisions and use specially-designed instruments. Small incisions usually result in less blood loss, a faster recovery and fewer complications than open surgeries.

In some cases, patients who have undergone laparascopic gastric bypass can go home the next day.

As effective as gastric bypass surgery can be for weight loss, it is a serious medical undertaking with risks every patient must consider. When the absorption of food is bypassed, patients are deprived of vital nutrients along with the calories.

Vitamin and mineral supplements must be taken for life, and patients will need to follow certain diet restrictions and stay active to maintain their weight loss.

Other risks — though rare — are complications following surgery, including bleeding, infection, intestinal leaking or obstruction and wound problems.

Some problems may require a second procedure to correct, bringing risks of another surgery. Additionally, obese surgical patients are shown to have an increased risk of complications with anesthesia, such as breathing problems, pneumonia, blood clots, cardiac problems and even death.

Choosing a physician who is experienced in performing gastric bypass surgery, including laparoscopy when appropriate, can result in a better outcome.

Patients who undergo gastric bypass surgery will need skilled follow-up care. If you are researching a clinic offering gastric bypass surgery, be sure that in addition to a highly-qualified surgeon, you will have access to specially-trained staff, including dieticians. Inquire about support groups or other resources that will be available to you.

Bottom line: Is weight loss surgery right for you? Considering whether the risks outweigh the potential benefits is a good place to start.

For people with obesity-related diseases including diabetes, high blood pressure and sleep apnea, weight loss surgery can mean achieving better health and a longer life.

And while there are no guarantees with any weight loss method, including surgery, having both the knowledge and the determination to do your part will greatly increase your chances of success.

Jeffrey Hunter, MD, and Katherine Redmon, PA-C, practice at Virginia Mason Federal Way. Dr. Hunter is the medical director of Virginia Mason Federal Way, and the director of bariatric surgery at Virginia Mason Medical Center in Seattle. More information is available by calling (253) 874-1604.

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