- The concept of surgery to control obesity grew out of the
results of operations for stomach cancer or severe ulcers where
portions of the stomach or intestines were removed. Because
patients who underwent these procedures tended to lose weight, some
physicians began to use these operations to treat severe obese patients.
The first operation that was widely used for
severe obesity was the intestinal bypass. This operation, first
used more than 40 years ago, produced weight loss by something called “malabsorption”.
The idea was that patients could eat large amounts of food, which
would be poorly digested so that the body could not absorb the calories. Even
though this surgery is no longer used in its
original form, modified techniques of this surgery are being performed
today. In addition to the malabsorptive component, a restrictive
component was added, resulting in the patient left with the ability
to consume and absorb small amounts of food at the same time.
- The surgical procedures that are used to
promote weight loss are
- - a surgery that limits
the amount of food the stomach can hold
by having an adjustable silicone band
being placed around the upper part of
the stomach. This creates a new
small pouch with the larger part of the
stomach below the band. The pouch
above the band can only hold a small
amount of food so that you feel full
sooner and the feeling lasts longer.
- - The
American Society of Bariatric Surgeons
and the NIH consider this procedure to
be the gold standard for surgical weight
loss. This procedure surgically
creates a small stomach pouch, bypasses
the larger native stomach and the first
segment of the small intestine called
the duodenum, where most absorption takes
place. The patient not only eats
smaller amounts to food, but what they
eat is not fully absorbed, thus
creating large weight losses.
- - This procedure
generates weight loss solely through
gastric restriction (reduced stomach
volume). The stomach is restricted by
stapling and dividing it vertically and
removing more than 85% of it. This part
of the procedure is not reversible. The
stomach that remains is shaped like a
very slim banana and measures from 1-5
ounces. The nerves to the stomach and
the outlet valve (pylorus) remain intact
with the idea of preserving the functions
of the stomach while drastically reducing
the volume.
Although there may be some exceptions depending
on each individual, the following criteria must be met before
a candidate is accepted for a surgical weight loss procedure
- Demonstration of one or more supervised non-surgical weight loss attempts for 6-12 consecutive months within the last year. They can be from one of the following:
- weight reduction programs such as Weight
Watchers or a registered dietitian
- a physician monitored medication program
- monthly visits with your primary care physician
where diet is mentioned and weights are monitored.
- Willingness to make necessary changes in eating habits and demonstrated motivation toward weight loss
- Absence of medical problems that would make surgery/ anesthesia hazardous
- Must be Over 18
- Must be at least 100 pounds over the recommended weight
for your age, height and gender or have a Body Mass
Index of 40 or greater
- If there is a Body Mass Index of 35-39 there needs to be documented medical problems such as hypertension, diabetes, joint problems, pulmonary function abnormalities or any other medical conditions that would be improved or alleviated by weight loss.
For those who remain severely overweight when non-surgical
approaches have not been successful, or for people
who have obesity-related diseases, surgery may
be the solution. You
should consider the following when making your
decision to undergo weight loss surgery:
- The likelihood that you will be able to lose
weight successfully with further non-surgical
methods.
- How informed are you about the surgical procedures?
- How motivated are you to lose weight and improve
your health?
- Your knowledge of how your life may change after
the operation.
- Your knowledge of the potential for serious
complications
With the altered size of your stomach and
by eating only the amount of food recommended in
your diet, your daily food intake will be decreased. With this will
come a weight loss of as much as five to six pounds per week
(with the bypass) or one to two pounds per week (with the band)
for the first twelve to eighteen months.
The rate at which you will lose
weight will decrease gradually until you reach a stable healthy
weight. Additional weight can be lost with a
concentrated effort which includes incorporating exercise into your life.
In addition to looking better,
weight loss improves most obesity-related conditions,
including diabetes, sleep apnea, joint problems
and hypertension. Many
patients can reduce the number of medications they
must take or eliminate medications altogether. Many patients
also report a greater feeling of personal development
potential as a result of their renewed sense of self esteem. There
are many factors that contribute to weight loss. Among
the most important are your age, gender and initial
weight at the time of surgery. Your willingness
to make the necessary adjustments in your present
habits is essential to the ultimate success of
the procedure.
- Any surgery entails a certain amount of risk,
and complications cannot always be avoided. It
should be noted that the risks/complications
listed are rare, however, if they happen it may
require a revisional surgery. Therefore, before
making the decision to undergo surgery it is
important to consider the following:
- With the gastric Lap Band System some risks/complications are:
- Gastric perforation or tearing in the stomach
- May not provide the necessary feeling
of having had “enough to eat”
- Nausea and vomiting
- Outlet obstruction
- Pouch dilatation
- Band migration/slippage
- With the Gastric Bypass and Sleeve Gastrectomy some risks/complication
are:
- Pulmonary embolism (blood clot
in the lungs)
- Blockage where the tissues are
sewn or stapled together
- Leakage from the staple or suture
line
- Pneumonia
- Infection
- Bleeding
- Gallstones
- Vomiting
- Insufficient weight loss
- Death
The answer is NO. At the Weight Loss
Institute of New Jersey we offer a multidisciplinary team approach.
You will have the support of not only the bariatric surgeon,
but the clinical program director, bariatic navigator, psychologist,
exercise physiologist and registered dietitian. In addition,
there are monthly support group meetings in which people who
are considering the surgery, waiting or have had the surgery
attend. Experience tells us that those who attend the
support group meetings are more successful because the environment
of the groups helps improve your self-esteem while keeping
you motivated.
Many insurance companies do not cover these
procedures. Insurance providers understand that severe obesity can contribute to multiple health problems. The
knowledgeable staff at the Weight Loss Institute
will work with you and your insurance company
to help make the necessary financial arrangements.
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