Gastric Bypass Information

Types of weight loss surgery

There are many medical procedures available to help with weight loss. The two most common are Lap Band (an adjustable stomach band used to decrease the size of the stomach) and Roux en Y gastric bypass. The most effective of these is the gastric bypass, so the information presented here will deal with that procedure.

Why does gastric bypass work so well?

Gastric Bypass is becoming much more common in the United States because it has proven very effective for long-term weight loss and has minimal side-effects and an acceptable level of risk. A report issued by Health and Human Services' Agency for Healthcare Research and Quality ("AHRQ") concludes that

Surgery for extremely obese patients who have tried and failed to lose weight with exercise and diet may be more effective for weight reduction. It can also improve control of some obesity-related health problems such as high blood pressure and diabetes.

During surgery, the surgeon staples your stomach across the top, sealing it off from the rest of your stomach and leaving only a tiny pouch that can hold about a half an ounce of food. Then the surgeon cuts the small intestine and sews part of it directly onto the pouch.

This redirects food, bypassing most of your stomach and the first section of your small intestine. Food enters directly into the second section of your small intestine, the jejunum, limiting your ability to absorb calories. This results in weight loss. Even though food never enters the lower part of your stomach, the stomach stays healthy and continues to secrete digestive juices to mix with food in your small intestine.

Can anyone have gastric bypass surgery?

According to the American Society for Bariatric Surgery, its member surgeons performed 63,100 weight-loss operations in the United States in 2002, up from 28,800 in 1999. Despite this surge in popularity, gastric bypass surgery isn't for everyone who is obese. It's a major procedure, accompanied by significant and indefinite lifestyle changes, risks, and side effects.

The qualifications for a potential gastric bypass patient are:

• A BMI greater than 40 (twice your ideal weight – 100% overweight) or 100 lbs. or more over your ideal weight.
• A BMI greater than 35 with comorbid conditions (i.e., hypertension, high cholesterol, sleep apnea, etc.)
• Severe obesity duration (greater than 5 years)
• Failure of medical weight management
• Appropriate pre-operative evaluation
• Informed consent
• Lack of an absolute contraindication (a condition that would render the procedure deadly or would gravely impact the health of the patient)

A life-long commitment

Someone who chooses gastric bypass must understand that it is a life-long commitment. There will be changes that strongly affect what you may eat and what you must eat. After gastric bypass you must limit sugar intake and eliminate concentrated sugars altogether. You must limit your fat intake. You must maintain a significant protein level in your foods and supplements. And you must take regular nutrient supplements including B-12, calcium, and multi-vitamins.

In addition to the food and nutrient requirements, you'll need to make regular appointments with your doctor to ensure that you're getting the appropriate nutrients and that everything is working as it should.

Weighing the risks and benefits

Many surgeons prefer gastric bypass because it is safe and effective and has fewer complications than other weight-loss surgeries. Also weight loss is more predictable and usually maintained. Most people eventually lose at least half their excess weight and about two-thirds keep the weight off for 10 years and longer. Along with weight-loss benefits, however, the operation poses these risks:

• Death. The National Institutes of Health reports that about one in 200 to 300 people who has gastric bypass surgery in the United States dies from the procedure.
• Narrowing of the opening between the stomach and small intestine. This rare complication may require an outpatient procedure to pass a tube through your mouth to widen (dilate) the narrowed opening or corrective surgery.

Other more common but less serious side effects include:

• Iron deficiency. You need iron to make red blood cells. Your stomach and duodenum absorb iron from digested food. That process is disrupted with a bypass. Taking a daily multivitamin with iron can prevent or reverse this potential side effect, which is greatest in women with heavy monthly periods.
• B-12 deficiency. The surgery also increases your risk of becoming deficient in vitamin B-12, which you also need to make red blood cells and to preserve nerve function. To prevent this, you'll need to take vitamin B-12 supplements for the rest of your life.
• Gallstones. You're at greater risk of developing gallstones � solid deposits of cholesterol or calcium salts that form in your gallbladder or nearby bile ducts � if you're overweight or lose weight rapidly. A surgeon also finds gallstones occasionally during surgery for obesity.
• Bleeding ulcer. This can occur where your small intestine is attached to the upper part of your stomach. According to the Mayo Clinic, about 1 in 100 people may develop a bleeding ulcer, which medication often can manage but may require surgery.

Dramatic results

Gastric bypass surgery can have dramatic results. The National Institutes of Health statistics show:

• In the first 12 to 24 months, most people lose 50 percent to 60 percent of their excess weight. Generally, those who follow dietary and exercise recommendations keep most of that weight off 10 years and longer.
• People who are severely obese and have type 2 diabetes (formerly called adult-onset or noninsulin-dependent diabetes) typically see improvement in control of their blood sugar levels, or blood sugar levels become normal.
• High blood pressure disappears in about two-thirds of those who have weight-reduction surgery, and many with sleep apnea enjoy marked improvement, including less daytime sleepiness.

But don't expect it to be a piece of cake (you won't be eating much cake after gastric bypass surgery—too much sugar). You'll have a stomach pouch about the size of a small egg. In the first six months after surgery, eating too much or too fast may cause either vomiting or an intense pain under your breastbone.

The Mayo Clinic says that "surgery for weight reduction is not a miracle procedure. Though you can generally expect to lose weight and keep it off, especially if you have a gastric bypass, changes needed in your eating and exercise habits are yours to make. But health benefits of losing weight are yours as well."

Consult with your doctor

Check your BMI. If it is above 40 or if you have comorbid conditions along with a BMI of 35.1 or greater, talk to your doctor about the possibilities of weight loss surgery. If surgery is recommended, research the bariatric surgeons in your area. Choose the best one, follow the nutritionist's advice, begin exercising when your surgeon says it's okay to do so, and you'll quite likely find that your whole life will be changed.

Talk to me

If you'd like to talk to me about my experience or about things you may be going through regarding weight issues and weight-loss surgery, shoot me an e-mail.