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Obesity Surgery: Who is a Candidate, How does it Help?

separator You may have seen the recent headlines that having surgery for obesity can “cure” diabetes. The Journal of the American Medical Association has published a review of 136 studies of 22,094 patients who had surgery for obesity, also called “bariatric surgery.” The survey looked at four of the complications associated with obesity:

  • Diabetes
  • High blood pressure
  • High blood fats (including cholesterol)
  • Sleep apnea

The survey found that a “substantial majority” of patients undergoing the surgery experienced either improvement in or a resolution (elimination) of these four health problems.

For anyone who is obese and has diabetes, this kind of news probably makes you sit up and take notice and think about whether you should have the surgery yourself. That’s a decision you and your doctor need to make together, of course.

There’s no question that people who are obese have a very hard time losing weight and keeping it off. Statistics show that only about 5 percent of obese people have long-term weight loss success. Many surgeons who perform bariatric surgery believe that obesity itself is a disease. They believe that the operation is the best way to help obese people fight their disease and recover from life-threatening health problems.

Here are some basics about the surgery itself and a general description of the type of screening process that most doctors conduct before agreeing to perform the procedure.

How the surgery works
In the United States, the most commonly performed obesity surgery is called “roux-en-Y gastric bypass.” Doctors usually choose this particular procedure because it has a high rate of effectiveness and a lower rate of complications.

During the operation, surgeons close off part of the stomach, creating a small pouch. They then attach part of the small intestine to the pouch. This reduces the amount of nutrients and calories your body is able to absorb.

As with any type of operation, bariatric surgery does have complications that may arise, including infection, tearing or leaking of the stitches and formation of blood clots. There are also long-term complications that may occur, such as malnutrition due to the decreased capacity of the intestine to absorb nutrients.

After the surgery, you need to limit yourself to eating only ½ to 1 cup of food at a time—for the rest of your life. You also will have to strictly limit sugar and fat, because eating too much of these foods—candy and other desserts, chips, etc.—can cause you to feel severe stomach cramping.

Because of the risk of malnutrition after the surgery, you need to focus on eating healthy food, but you also have to take nutritional supplements for the rest of your life. An additional problem that many people experience after they lose a lot of weight is sagging skin, which can cause serious chafing problems and infections. Many people who have bariatric surgery eventually feel the need for additional surgery to treat this new problem.

As you can see, having bariatric surgery is a serious decision. It requires major life changes and real commitment to living your life a different way. Most bariatric surgeons believe that patients should think of the operation as a last resort, only to be done after other weight loss attempts have failed.

Who is a candidate?
The screening process to identify who is a good candidate for the surgery varies from doctor to doctor, but in general, most patients have to meet the following criteria to qualify:

  • A body mass index (BMI) of 35 to 40 with some of the complications of obesity, such as diabetes, high blood pressure, sleep apnea and high cholesterol
  • A BMI over 40 with no complications of obesity
  • Proof that you’ve tried and failed to lose weight numerous times

Additionally, doctors conduct the following types of screening

  • Complete physical exam and extensive lab workups
  • Letter from your primary care doctor giving you clearance to have the procedure
  • Psychiatric screening to make sure you are likely to be able to handle the major life changes the surgery requires
  • Psychiatric screening for depression
  • Commitment from you to eat healthy foods in the right amounts and to exercise regularly
  • Commitment from you to participate in a support group before and after the surgery
  • Commitment from you to take the required nutritional supplements
  • Commitment from your spouse and other family members to support your efforts to lead a healthy lifestyle

Bariatric surgery is a tool that people have used to get them back on track to lead a healthy lifestyle. It’s not a quick fix. But for people who have tried and failed to lose weight, over and over again, the surgery offers a new option.

Source:
American Society for Bariatric Surgery; Journal of the American Medical Association, 13 October 2004; National Institutes of Health.



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