Weight Loss Surgery...An Acceptable Risk?

I have never recommended weight loss surgery to anyone and can't imagine doing so in the future as I believe a healthy diet and exercise can overcome the problems of obesity.

Everything I have written about and spoken about to my clients and believe in for myself revolves around a proper diet and age-appropriate, regular exercise to stay fit and in a healthy weight range.

But, unfortunately for some, it is felt that other methods are sometimes needed. Whether through long-term poor development of willpower, genetic disposition, disease or other factors, losing a large amount of weight and then maintaining that weight, for the cronically obese, sometimes requires drastic measures.

Generally these people have tried numerous fad diets that haven't worked, and in almost every case the weight has yo-yo'd up and down, but always ending up higher than at the start of the diet. Some nutritional supplements and other compounds can help to a degree. But for many in this situation, weight loss surgery becomes the last resort and their only perceived hope of success.

There are many forms of surgery these days and all have pros and cons. The most important criteria are effectiveness, risk and side effects.

Weight loss surgery techniques have evolved over the past few decades, and most are effective to a degree, in the sense that they can lead to substantial weight loss. That loss comes about usually as the result of restricted caloric intake by eating less or by absorbing less of the food that is eaten.

One of the earliest forms of weight loss surgery was gastric bypass surgery. All or part of the stomach was removed and the digestive system reconnected. The stomach ends up as only a slight pouch through which food quickly passes. Originally extremely dangerous, it has evolved but still carries substantial risks. It is no longer the preferred method. Patients who undergo the procedure have to take supplements forever after and the risk of disease and nutritional deficiencies remains high.

Stomach stapling is one weight loss surgery technique that has been around for many years now. Initially highly dangerous, it has become much safer in the past 10 years. There are still substantial risks, however, as with any major surgery. The effect is not much different than gastric bypass surgery except that the stomach is not removed, it is just made much smaller by clamping off a large portion.

The procedure consists of opening the patient and clamping portions of the stomach with specialized surgical staples. Newer methods sometimes make possible laparoscopy, in which a small hole is created through which the surgeon works, but the patient isn't opened up.

There are risks of bleeding, though small. Patients can become ill if they attempt to eat more than the recommended amount. They may also suffer from nutritional deficiencies that can be lifelong, requiring supplements.

The net effect is to create a smaller stomach, leading to a more rapid feeling of fullness. The patient simply eats less and therefore takes in fewer calories. The body turns to stored fat for energy and the result is less fat and lower weight.

A newer form weight loss surgery involves installing an adjustable Lap Band around the stomach (Laparoscopic gastric banding). This eliminates the need to puncture the stomach and makes it possible for the physician to adjust the effect as the patient loses weight.

Generally safe, the procedure can be done on an outpatient basis. Most consider it a minor inconvenience, though like any medical procedure it's expensive and insurance companies increasingly won't pay for it. The band itself is not painful.

The Lap Band System is an adjustable ring that is placed over the upper stomach to create a small pouch. The ring is attached to tubing which itself is attached to a port that lies under the skin. The tightness of the ring is adjusted after surgery during routine office visits. If a patient does not experience adequate weight loss, fluid is added through the port and the band tightens creating a smaller pouch and a sense of early fullness after meals. If too much fluid is present such that the patient cannot tolerate any solid food, fluid is removed from the band. Using these adjustments, the band can be fine-tuned for each patient.

Patients typically experience rapid weight loss, but at the same time (as fat comes out of adipose tissue) many hormonal changes take place. Close, regular medical observation is important for the success of the procedure and the health of the patient.

There are dozens of names for the various procedures, Biliopancreatic Diversion, Vertical Banded Gastroplasty, Adjustable gastric band, sleeve gastrectomy (with or without Duodenal Switch), Roux-en-Y gastric bypass and others. All are termed bariatric surgery.

But whichever procedure an individual considers, careful thought should be given to weighing the risks and benefits. For many, a commitment to long-term dietary and lifestyle changes is a better option. For those who believe weight loss surgery is the best option, please consult with an experienced physician.

Avoid weight loss surgery if you know how!


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