Patients who are morbidly or severely obese are at increased risk for health problems and tend to have a shortened life span. There is also added potential risk from continued weight increase. The risk of severe obesity is greater than that of its surgical treatments. Persons eligible for bariatric surgery include the following:
Persons who have a body mass index (BMI) greater than 40.
Persons who have a BMI greater than 35 and have life-threatening obesity related problems such as diabetes, hypertension, sleep apnea, etc.
Above persons who have failed non-surgical attempts at weight loss, specifically a combined regimen of diet and exercise.
Surgery has become a widely acceptable method of treatment for clinically severe obesity because it appears to be the only option which can provide long-term maintained weight loss in-patients with clinically severe obesity. In fact, the number of patients having surgical treatment of obesity has doubled in recent years. Currently, the two leading approaches to weight-loss surgery in the United States are sleeve gastrectomy and Roux-en-Y gastric bypass. Weight-loss surgeons should be skilled in more than one surgical approach as the specific procedure needs to be carefully matched to the individual patient.
How Surgery Causes Weight Loss
Procedures for weight loss are either restrictive and /or malabsorptive: they restrict the intake of food and/or cause some of the food to be poorly digested and absorbed, and therefore eliminated in the stool. The LAP-BAND® is an example of a "restrictive" surgeries, whereas the Roux-en-Y gastric bypass and duodenal switch are "combination" type procedures resulting in both a restrictive and malabsorptive effect.
In surgery for obesity management, your stomach is reduced in size. Since your stomach pouch is very small, you will feel full very quickly. Overeating can be very uncomfortable and may result in vomiting. Your eating habits will therefore change drastically and you will likely never be able to eat the quantity of food that you can currently eat. For example, a typical size lunch for most patients is half a sandwich and a piece of fruit.
Weight loss varies widely, depending on many factors, such as the patient’s age, starting weight, ability to exercise and the type of operation used. On average, patients lose one half to two thirds of their initial excess weight at the end of one year.
Surgery's Effect on Other Health Problems
The degree of improvement of various obesity-related problems depends on the extent of the illness and the length of time the patient has had it. The longer the patient has had the condition, the less likely it is for it to completely resolve after surgery. In general, more than half of the surgery patients find an improvement of their comorbidities. Nearly 80 percent of non-insulin dependent diabetes is controlled without medication after surgery. Obesity related respiratory problems, including sleep apnea and shortness of breath with minimal exercise, will become asymptomatic, improve or completely resolve. Joint and back pain associated with obesity, urinary incontinence, venous problems in the legs, acid reflux, menstrual irregularity, and certain types of headaches are also improved with weight loss after surgery.