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Weight Loss Surgery

Author: Dr. Edward Group 05/21/2009
 

By Dr. Edward F. Group III, DC, ND, DACBN, DABFM

Weight loss surgery as a last resort can successfully help severely overweight or obese people lose excess weight. There are several different types of weight loss surgeries to choose from. Consult your health care provider to discuss whether or not you make a good candidate for weight loss surgery, and which procedure would work best for you. Natural methods always work the best.

How Does Weight Loss Surgery Work?

There are two basic types of weight loss surgery that are currently used for weight reduction. Restrictive procedures work by decreasing food intake. Malabsorptive procedures, on the other hand, alter digestion, and cause food to be poorly digested and incompletely absorbed so that it is eliminated in the stool.

Restrictive Procedures:

Restrictive weight loss surgery works by altering the size of the stomach, to reduce the amount of food that can be consumed at one time. It does not, however, interfere with the normal absorption or digestion of food. A restrictive weight loss surgery involves the creation of a small stomach pouch in the upper portion of the stomach. The capacity of this pouch is about one half to one ounce. The pouch then connects to the rest of the stomach through an outlet known as a “stoma.” The reduced stomach capacity allows the patient to feel fuller with less food, and by decreasing overall food intake, the patient can achieve sustained weight loss. The success of this weight loss surgery ultimately depends upon the ability of the patient to alter his or her eating habits. After surgery, it is likely that the patient will only be able to consume a maximum of one half cup full of food at each sitting. Compliance with these requirements is necessary to avoid stretching the pouch and defeating the purpose of the surgery.

  • Vertical Banded Gastroplasty: This is restrictive weight loss surgery in which the upper stomach near the esophagus is stapled vertically for about 2-1/2 inches to create a smaller stomach pouch. The outlet or stoma that connects to the rest of the stomach is restricted by a band or ring that slows the emptying of the food and allows the patient to feel fuller with less food consumption. After 10 years, studies show that patients can maintain at least fifty percent of targeted excess weight loss.
  • Laparoscopic Adjustable Gastric Banding: This restrictive weight loss surgery, also called stomach banding, utilizes a band to divide the stomach into two portions. The band is placed around the upper most part of the stomach, dividing the stomach into a small upper portion and a larger lower portion. Because food is regulated, most patients feel full faster. Food digestion occurs through the normal digestive process. This surgery can be reversed as the band can easily be removed from the stomach. As with other weight loss surgeries, the success of this procedure is dependant on the compliance of the patient with a restricted diet and the development of an exercise regime.

Malabsorptive Procedures:

Weight loss surgeries that alter the digestive process are referred to as malabsorptive procedures. There are several different types of malabsorptive weight loss surgery. Some of these techniques involve a bypass of the small intestine, thereby limiting the absorption of calories. Malabsorptive weight loss surgery reduces the amount of intestine that comes in contact with food so that the body absorbs fewer calories.

  • Biliopancreatic Diversion: The goal of this surgery is to restrict the amount of food consumed and alter the normal digestive processes. It also involves the creation of a stomach pouch, but it is a larger pouch than one created in a restrictive weight loss surgery. Biliopancreatic diversion alters the anatomy of the small intestine to divert the bile and pancreatic juices so they meet the ingested food closer to the middle or the end of the small intestine. Patients report a greater degree of satisfaction with this procedure than with restrictive weight loss surgery, because they are able to eat larger meals. And this surgery provides the greatest amount of malabsorption, it also allows for the greatest amount of weight loss. But as with restrictive weight loss surgery, long-term success is dependent upon the patient’s ability to adhere to a dietary, supplement, exercise and behavioral regimen.

Combined Procedures:

  • Gastric Bypass Roux-en-Y is a recently developed procedure that utilizes the principles of both restrictive and malabsorptive weight loss surgeries. According to the American Society for Bariatric Surgery and the National Institutes of Health, Roux-en-Y gastric bypass is the most frequently performed weight loss surgery in the United States. This procedure involves the creation of a small stomach pouch with the remainder of the stomach completely stapled shut and divided from the pouch. The outlet from the pouch than empties directly into the lower portion of the jejunum, thus bypassing calorie absorption. By adding malabsorption to a restrictive weight loss procedure, food is delayed in mixing with bile and pancreatic juices that aid in the absorption of nutrients. The result is an early sense of fullness, combined with a sense of satisfaction that reduces the desire to eat.
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