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Is Weight Loss Surgery for You?

Severe obesity is a chronic condition that is very difficult to treat. For some people, weight loss surgery helps by restricting food intake or interrupting digestive processes. But keep in mind that weight loss surgery is a serious undertaking. You should clearly understand the pros and cons associated with the procedures before making a decision.

In order to understand how weight loss works, you need to first understand how the normal digestive process functions.

Normally, as food moves along the digestive tract, appropriate digestive juices and enzymes arrive at the right place and at the right time to digest and absorb calories and nutrients. After we chew and swallow our food, it moves down the esophagus to the stomach, where a strong acid continues the digestive process. The stomach can hold about 3 pints of food at one time. When the stomach contents move to the duodenum, the first segment of the small intestine, bile and pancreatic juices speed up digestion. Most of the iron and calcium in the foods we eat is absorbed in the duodenum. The jejunum and ileum, the remaining two segments of the nearly 20 feet of small intestine, complete the absorption of almost all calories and nutrients. The food particles that cannot be digested in the small intestine are stored in the large intestine (made up of the ascending colon, transverse colon, descending colon, sigmoid colon and rectum) until eliminated.

Obesity surgery involves making changes to the stomach and/or small intestine.

How Does Weight Loss Surgery Work?

The concept of gastric surgery to control obesity grew out of results of operations for cancer or severe ulcers that removed large portions of the stomach or small intestine.

Because patients undergoing these procedures tended to lose weight after surgery, some doctors began to use such operations to treat severe obesity. The first operation that was widely used for severe obesity was a type of intestinal bypass. This operation, first used 40 years ago, caused weight loss through malabsorption (decreased ability to absorb nutrients from food because the intestines were removed or bypassed).

The idea was that patients could eat large amounts of food, which would be poorly digested or passed along too fast for the body to absorb many calories. The problem with this surgery was that it caused a loss of essential nutrients (malnutrition) and its side effects were unpredictable and sometimes fatal. The original form of the intestinal bypass operation is no longer used.

Surgeons now use other techniques that produce weight loss primarily by limiting how much the stomach can hold. Two types of surgical procedures used to promote weight loss are:

• Restrictive surgery: During these procedures the stomach is made smaller. A section of your stomach is removed or closed which limits the amount of food it can hold and causes you to feel full.
• Malabsorptive surgery: Most of digestion and absorption takes place in the small intestine. Surgery to this area shortens the length of the small intestine and/or changes where it connects to the stomach, limiting the amount of food that is completely digested or absorbed (causing malabsorption). These surgeries are now performed along with restrictive surgery.

Through food intake restriction, malabsorption, or a combination of both, you can lose weight since less food either goes into your stomach or stays in your small intestine long enough to be digested and absorbed.

Weight Loss Surgery Helps Obese Women Have Healthier Pregnancies, Infants

Women who become pregnant after undergoing bariatric surgery have less complicated pregnancies and healthier infants than obese women who become pregnant, according to a new study, the New York Times reports. The new research -- which reviewed 75 earlier studies -- found that pregnant women who have lost weight after bariatric surgery may have lower rates of pregnancy complications such as gestational diabetes and pre-eclampsia and do almost as well as women who are not obese, the Times reports. In addition, their infants are healthier and may be less likely to be born too small or prematurely. According to the authors, fertility seemed to improve after surgery as hormone levels and menstrual cycles returned to normal.

The Times reports that about one-third of U.S. women are obese, and they usually are advised to lose weight before becoming pregnant because they have a high risk for developing pregnancy-related health problems. For example, their infants are more likely to be born prematurely or stillborn, to be very large, or to have a neural tube defect. Melinda Maggard, a general surgeon at the University of California-Los Angeles and an author of the study, said, "Intuitively, it makes sense to me that the maternal outcomes are better after bariatric surgery -- they lose weight and approach the outcomes of normal women." However, considering that more than 50,000 young women have bariatric surgery every year, Maggard said more research into the effects of the surgery is needed. Laura Riley, medical director of labor and delivery at Massachusetts General Hospital, said that morbidly obese patients often attempt to lose 10 or 15 pounds, "but the majority don't lose the weight and just come back pregnant." She added, "With this kind of data, it's easier to say, 'You are better off having bariatric surgery and losing 100 pounds and then getting pregnant.'"

According to Maggard, one of the most urgent unresolved questions regarding bariatric surgery has to do with the effectiveness of oral contraceptives in women who have had the procedure. Currently, no randomized trials have assessed the efficacy of birth control pills after bariatric procedures, including ones that affect the absorption of drugs and nutrients. Maggard said, "Until we have some better answers about oral contraceptives, women should consider other methods, such as barrier methods, to prevent unwanted pregnancies." She added that women who had had the surgery should "defer pregnancy until after the time of rapid weight loss," or about one year (Rabin, New York Times, 11/20).

Reprinted with kind permission from http://www.nationalpartnership.org. You can view the entire Daily Women's Health Policy Report, search the archives, or sign up for email delivery here. The Daily Women's Health Policy Report is a free service of the National Partnership for Women & Families, published by The Advisory Board Company.

Weight-Loss Surgery and Quality of Life

If you or someone you love is severely overweight, weight-loss surgery may be an option for a longer, healthier life.

People with substantial weight problems may have trouble getting around. Simple household tasks can be difficult. Stairs are a problem, as is walking any distance. Some aspects of personal hygiene can be difficult to maintain. Even tying your shoes or crossing your legs may not be possible. These types of personal limitations can greatly reduce your quality of life.

Faced with diminished physical ability, many severely overweight people may become convinced that things will only get worse. They may lose hope that a healthier future is possible. However, they should not despair.

Ample research-based evidence has shown that weight-loss surgery, as part of a life-long weight management program, can dramatically reverse many weight-related health problems and can greatly improve your quality of life. Even if you have or are developing such weight-related diseases as diabetes, osteoarthritis, sleep apnea, and high blood pressure, you still have effective treatment options to consider. The sooner you act, the better off you will be. In fact, you may actually prevent new health problems from developing.

Who Is a Candidate?
Your doctor is your best resource for finding out more about whether weight-loss surgery is right for you. Usually, the history of a patient's health and objective measures of weight are used to determine whether surgery is an option.

In general, candidates for weight-loss surgery meet all of the following criteria:

• A body mass index (BMI) of more than 40, or roughly 100 pounds (lb) or more, is considered seriously overweight for men; a BMI of more than 35, or 80 lb or more is considered seriously overweight for women, plus a history of associated medical disorders, such as diabetes, cardiopulmonary disease and obesity-induced musculoskeletal problems
• Aged at least 18 years, though some younger people may also be candidates
• A history of unsuccessful attempts at nonsurgical weight-loss treatments

A person who undergoes weight-loss surgery needs to make a lifelong commitment to a new lifestyle, including a new nutrition and exercise regimen, otherwise weight-loss surgery will probably not be effective.

Better Quality of Life
Research shows that maximum weight loss usually reaches about 70 percent of the excess weight after gastric bypass surgery, and 51 percent of the excess weight after adjustable gastric band surgery two years postoperative. However,the weight loss from both types of surgeries is equal after three to five years. There is also a tendency to regain some weight with gastric bypass, with the average excess weight lost remaining stable at 50 percent to 55 percent from five years to as long as 16 years after surgery.

Weight-related health problems will also improve, sometimes dramatically. Sleep apnea tends to disappear entirely with both gastric bypass and adjustable gastric banding. In addition, many patients see marked improvement in diabetes, asthma, blood pressure and muscle and joint pain.

The outcome from weight-loss surgery should not be measured solely by weight loss and improvements in medical conditions. After a substantial portion of the excess weight is lost and a patient's health improves, the improvement in quality of life is an equally important outcome.

You may find yourself able to do things you haven't done in years. You may also find that you are better able to live your life in the way you want to.

In studies that have sought to rate a patient's quality of life before and after weight-loss surgery, obesity has been shown to significantly lower a patient's rating of his or her quality of life. The primary objective of weight-loss surgery is to reduce the numerous consequences that may result from being very overweight, by improving a patient's health status, activity level, engagement in life and work productivity.

The authors of one quality-of-life study wrote that they were "quite surprised" to find that, in as little as two to four weeks after surgery, significant improvements were seen in their patients' perception of their overall health, depression and self-esteem. The researchers also found significant changes in energy levels and physical functioning much sooner after surgery than expected. Between several weeks and six months after surgery, patients showed improvements "on all measures assessed."

Many weight-loss surgery candidates have been very overweight for most of their lives and have had to adapt to the many physical, emotional and social consequences of obesity. Dramatic quality-of-life changes can occur after surgery, so patients need to be prepared. It is wise to expect that you may need some help coping with these challenges and the feelings they may generate.

Talk to Your Doctor
If you think you may be a candidate for the surgical treatment of obesity, the first step is to discuss the situation with your doctor. Together, you can consider how being overweight has affected your health and your life, and whether surgery would be a good option.

Sources
1. MacDonald KG, Schauer PR, Brolin RE, Scopinaro N, O'Brien P, Doherty C. Bariatric surgery: a review. Gen Surg News. 2002;29:19-26.

2. Gastric bypass. Medline Plus®Web site, US National Library of Medicine and the National Institutes of Health. Available at: http://www.nlm.nih.gov/medlineplus/print/ency/article/007199.htm. Accessed March 20, 2006.

3. Dymek M, Le Grange D, Neven K, Alverdy J. Quality of life after gastric bypass surgery: a cross-sectional study. Obes Res. 2002;10:1135-1142.