Weight loss surgery

Also called Bariatric surgery, weight loss surgery is an option for treatment of moderate to severe obesity, especially if non-surgical weight loss options were not successful or who suffer from serious health problems related to obesity.

Gastric bypass icon

Roux-En-Y Part 2

The surgery restricts food intake using various surgical measures limiting the amount of food that can be taken in at a time leading to weight loss and potentially reduces the risk of health problems related to obesity such as type 2 diabetes. However, many of these bariatric surgical procedures may also interrupt how food is digested, preventing some calories and nutrients, such as vitamins, from being absorbed.

How does bariatric surgery work?

Using various mechanical devices to reduce the size of the stomach or by surgical measures, bariatric surgery attempts to limit the size of the stomach so you can only take in smaller amounts at a time.

Types of Gastric Bypass

• Adjustable Gastric Band
• Sleeve Gastrectomy
• Gastric Bypass
• BPD/DS precedures

Bariatric weight loss surgery for adults

Given the significant health risks including death, bariatric surgery is not an option for everybody. However, it may be an option for some dealing with severe obesity, defined generally as those that have a body mass index of 40 or a BMI > 35 with a serious health problem linked to obesity such as type 2 diabetes, high blood pressure, sleep apnea, or heart disease.

Lower BMI patients and Bariatric Surgery

More recently, the United States Food and Drug Administration (FDA) has approved use of an adjustable gastric band (or AGB) for patients with BMI > 30 with at least one condition linked to obesity.

Indications for Bariatric Weight Loss Surgery

Bariatric surgery may be considered in the following patients.

• Obese patients that are unlikely to lose weight or keep it off over the long term using other non-surgical measures to lose weight.
• Obese patients that are well informed about bariatric surgery and treatment effects
• Obese patients that are aware of the risks and benefits of the bariatric weight loss surgery
• Obese patients that are informed and aware of how life may change after the surgery such as the need to adjust to side effects, need to chew food well and the loss of ability to eat large meals.
• Obese patients that are aware of the limits on food choices, and occasional treatment failures and or complications with weight loss surgery.
• Obese patients that are willing to lifelong healthy eating and physical activity, follow-up, and the need to take extra vitamins and minerals

Limitations of bariatric weight loss surgery

It is important to realize that there are no sure methods, including bariatric weight loss surgery, succeed in helping one lose weight or maintain the weight loss. It is also important to realize before considering bariatric weight loss surgery that some patients that have undergone bariatric surgery may not be able to meet their weight loss goals.

Weight regain after bariatric surgery

Research also suggests that many post gastric by pass patients that initially succeeded in losing weight may eventually regain some or all of the lost weight over time although the amount of weight regain may vary by extent of obesity and type of surgery.

Bariatric weight loss surgery for youth and children

The epidemic of obesity also affects up to one in three young adults and children. Although it is not commonly advocated or used, bariatric weight loss surgery is sometimes used to treat youth and children with extreme obesity. However, there are many questions that need to be answered about the long-term effects on teens' developing bodies and minds although bariatric surgery can help these lose weight. Before considering weight loss bariatric surgery, the families should think about surgery solely once youth have tried for a minimum of six months such as the W8MD medical weight loss program] to slim and have not had success.

Indications for pediatric or teen bariatric weight loss surgery

• Have extreme or morbid obesity with a body mass index or BMI of over 40
• Be their adult height (usually at age 13 or older for ladies and 15 or older for boys)
• Have serious health issues coupled to weight, such as type a pair of diabetes or sleep apnea, which will improve with bariatric surgery

Mechanism of action of bariatric weight loss surgery

Normally, as food moves on the digestive tube, biological process juices and enzymes digest and absorb calories and nutrients. once we tend to chew and swallow our food, it moves down the muscular structure to the stomach, wherever a strong acid continues the {digestive|organic process|biological process} process. The stomach will hold about three pints of food at just one occasion. once the stomach contents move to the small intestine (the first part of the little intestine), digestive juice and pancreatic juice speed up digestion. Most of the iron and calcium within the food we tend to eat is absorbed there. the opposite 2 elements of the nearly 20 feet of intestine absorb nearly all of the remaining calories and nutrients. The food particles that can't be digested within the intestine reside within the gut until eliminated.

Bariatric surgery restricts food intake, which leads to weight loss. Patients World Health Organization have bariatric surgery should plan to a lifespan of healthy ingestion and regular exercise. These healthy habits could facilitate patients maintain weight loss once surgery.

Difference between open and laparoscopic bariatric surgery

Bariatric weight loss surgery is also performed through "open" approaches, which involve cutting the stomach within the normal manner, or by laparoscopy. With the latter approach, surgeons insert advanced instruments through 1/2-inch cuts and guide a small camera that sends images to a monitor. Most bariatric surgery nowadays is laparoscopic as a result of it needs a smaller cut, creates less tissue damage, leads to earlier hospital discharges, and has fewer issues, especially hernias occurring once surgery.

However, not all patients are suitable for laparoscopy. Patients World Health Organization are thought-about very obese, World Health Organization have had previous stomach surgery, or World Health Organization have advanced medical issues could require the open approach. Advanced medical issues could include having severe heart and lung malady or consideration over 350 pounds.

What are the surgical options? There are four varieties of operations that are commonly offered within the United States: AGB, Roux-en-Y viscus bypass (RYGB), biliopancreatic diversion with a duodenal switch (BPD-DS), and vertical sleeve operation (VSG). (See Figure below) each surgery has its own advantages and risks. The patient and supplier ought to work together to select the most effective choice by considering the advantages and risks of every sort of surgery. alternative factors to consider include the patient's BMI, ingestion habits, health conditions associated with being obese, and former stomach surgeries.

Adjustable gastric band or lap band for weight loss

AGB works chiefly by decreasing food intake. Food intake is reduced by placing a small bracelet-like band round the prime of the stomach to limit the size of the opening from the throat to the stomach. The operating surgeon will then control the size of the opening with a circular balloon inside the band. This balloon are often inflated or deflated with isosmotic solution to meet the requirements of the patient.

Roux-en-Y Gastric bypass or the traditional weight loss surgery

RYGB restricts food intake. RYGB conjointly decreases however food is absorbed. Food intake is limited by a small pouch that is similar in size to the pouch created with AGB. Also, causation food directly from the pouch into the little internal organ affects however the digestive tube absorbs food. The food is absorbed differently as a result of the stomach, duodenum, and higher internal organ no longer have contact with food.

Biliopancreatic Diversion with a duodenal Switch

BPD-DS, usually observed as a "duodenal switch," is a advanced bariatric surgery that includes} 3 features. One feature is to remove an oversized part of the stomach. This step makes patients feel full sooner once ingestion than they did before surgery. Feeling full sooner encourages patients to eat less. Another feature is re-routing food away from much of the little internal organ to limit however the body absorbs food. The third feature changes however digestive juice and alternative biological process juices have an effect on the body's ability to digest food and absorb calories. This step conjointly helps result in weight loss.

In removing an oversized part of the stomach, the operating surgeon creates a a lot of cannular "gastric sleeve" (also called a VSG, mentioned later). The smaller stomach sleeve remains coupled to a awfully short part of the small intestine, which is then directly coupled to a lower part of the little internal organ. This surgery leaves a small part of the small intestine on the market to absorb food and a few vitamins and minerals.

However, once the patient fare food, it bypasses most of the small intestine. the distance between the stomach and colon becomes much shorter once this operation, therefore limiting however food is absorbed. BPD-DS produces significant weight loss. However, a decrease within the amount of food, vitamins, and minerals absorbed creates chances for long-term issues.

Some of these issues are anemia (lower than traditional count for red blood cells) or osteoporosis (loss of bone mass that may create bones brittle).

Vertical Sleeve operation

VSG surgery restricts food intake and decreases the amount of food used. Most of the stomach is removed throughout this surgery, which may decrease hormone, a endocrine that prompts appetite. Lower amounts of hormone could reduce hunger over alternative purely restrictive surgeries, such as AGB.

VSG has been performed within the past chiefly because the first stage of BPD-DS (discussed earlier) in patients World Health Organization is also at high risk for issues from a lot of in depth varieties of surgery. These patients' high risk levels are because of weight or medical issues. However, more recent analysis indicates that some patients World Health Organization have VSG will lose lots of weight with VSG alone and avoid a second procedure. Researchers don't nevertheless shrewdness many patients World Health Organization have VSG alone will would like a second stage procedure.

Complications and side effects of gastric bypass surgeries

Some of the expected problems, and complications associated with gastric bypass weight loss surgeries include trauma, infection, leaks from the positioning wherever the intestines are seamed together, diarrhea, and blood clots within the legs that may move to the lungs and heart.

Other side effects of weight loss surgery may include nutrients being poorly absorbed, especially in patients World Health Organization don't take their prescribed vitamins and minerals. In some cases, if patients don't address this drawback promptly, diseases could occur beside permanent damage to the system. These diseases include pellagra (caused by lack of sustenance B3—niacin), beri beri (caused by lack of sustenance B1—thiamine) and kwashiorkor (caused by lack of protein).

Other late issues after gastric bypass surgery include strictures (narrowing of the sites wherever the internal organ is joined) and hernias (part of an organ bulging through a weak area of muscle).

Two forms of hernias could occur once a patient has bariatric surgery including an incisional rupture is a weakness that stands out from the abdominal wall's animal tissue and may cause a blockage within the intestine and an indoor rupture occurs once the little intestine is displaced into pockets within the lining of the abdomen. These pockets occur once the intestines are seamed together. Internal hernias are thought to be a lot of dangerous than incisional ones and need prompt attention to avoid serious issues.

Some patients might also require emotional support to help them through the changes in body image and private relationships that occur once the surgery.

Cost of bariatric weight loss surgery in the United States

Bariatric procedures, on average, value from $20,000 to $25,000. Medical amount varies by state and insurance supplier. In 2004, the U.S. Department of Health and Human Services reduced barriers to getting Medicare coverage for blubber treatments. Bariatric surgery is also coated under these conditions:

• If the patient has a minimum of one pathological state coupled to being obese
• If the procedure is suitable for the patient's medical condition
• If approved surgeons and facilities are concerned

Weight loss bariatric surgery research

In 2003, the National Institute of diabetes and biological process and kidney Diseases (NIDDK) of the federal agency partnered with researchers to form the Longitudinal Assessment of Bariatric Surgery, or LABS. LABS researchers are specialists in bariatric surgery, blubber analysis, internal medicine, activity science, and related fields. Their mission is to plan and conduct studies which will result in a lot of knowledge about bariatric surgery and its impact on the health and well-being of patients with extreme blubber. a lot of data about LABS is obtainable at http://www.niddklabs.org Exit Disclaimer.

To help confirm if bariatric surgery is suitable for youth, federal agency launched Teen-LABS in 2007. From 2007 to 2012, the multicenter study is grouping data from teens World Health Organization plan to have surgery. the information will facilitate to guage bariatric surgery's advantages and risks. Researchers are grouping data about medical issues associated with blubber, alternative health risk factors, and quality of life from these patients before they need surgery and a couple of years once surgery. Researchers will then compare the teen outcomes to data from adults. These websites supply a lot of data about Teen-LABS: http://www.nih.gov/news/pr/apr2007/niddk-16.htm Exit Disclaimer and http://www.cincinnatichildrens.org/teen-LABS. Exit Disclaimer

Resources for Bariatric Surgery

The following list of publications, websites, and organizations is also of use for patients or health care suppliers discussing bariatric surgery.

• Additional Reading from the Weight-control data Network
• Active at Any Size. This reality sheet provides ideas and tips on however people thought-about to be overweight or obese are often physically active. It focuses on overcoming common barriers and setting goals. on the market at http://www.win.niddk.nih.gov/publications/active.htm.

Binge disorder. This reality sheet provides data and resources for patients World Health Organization could have binge disorder. on the market at http://www.win.niddk.nih.gov/publications/binge.htm.

Dieting and Gallstones. This reality sheet explains what gallstones are, however they kind, and the roles blubber and rapid weight loss play in developing gallstones. on the market at http://www.win.niddk.nih.gov/publications/gallstones.htm.

Resources for Health Care Professionals on Bariatric Surgery

Pharmacological and surgical treatment of Obesity: proof Report/Technology Assessment: variety 103. Shekelle PG, Morton SC, Maglione M, et al. Agency for attention analysis and Quality (AHRQ). AHRQ Publication variety 04–E028–1; 2004. Rockville, MD. This report reviews the scientific proof on weight-loss drugs and bariatric surgery among children, youth, and adults. on the market at http://archive.ahrq.gov/clinic/epcsums/obesphsum.pdf

How does bariatric surgery compare to medical weight loss?

Partly because of our misunderstanding of the true causes of obesity, the medical community until recently did not quite understand what triggers the overeating seen in many people that gain weight. According to Dr. Prab R. Tumpati, MD, founder of W8MD medical weight loss centers of America and a leading weight loss physician, the process that makes obese people go in to a state of internal metabolic starvation is called insulin resistance.

Since the body's compensation to insulin resistance is to increase the production of the body building hormone called insulin. While this keeps the blood sugars under control for the most part, this compensation to insulin resistance comes at the cost of weight gain.

Interestingly, this high amount of insulin seen in many non-diabetic obese people also lead to a process called metabolic starvation whereby their own fat stores become unavailable. It is like having a Swiss bank account in to which you can deposit, but you lost the password or code to withdraw!

Although bariatric surgery might initially lead to weight loss, unless there is a medical weight loss or behavior change plan after the bariatric surgery, most people tend to regain the weight.

Bariatric surgery comprises a group of procedures executed on individuals who have obesity. These surgeries aim to facilitate weight loss by modifying the digestive system's structure or functionality, such as reducing stomach size or re-routing the small intestines. Bariatric surgery is usually considered when diet and exercise are insufficient or when obesity-related health conditions are present.

An illustration of gastric bypass, a type of bariatric surgery

Types of Bariatric Surgery

There are several types of bariatric surgery, each with its unique advantages and potential complications. The primary procedures include:

Roux-en-Y Gastric Bypass (RYGB): This surgery creates a small pouch at the top of the stomach, effectively reducing its size. The surgeon then attaches a section of the small intestine directly to this pouch, bypassing most of the stomach and the initial portion of the small intestine.

Vertical Sleeve Gastrectomy: This procedure involves the removal of approximately 80% of the stomach, leaving behind a tube or sleeve-like structure. This results in a smaller stomach capacity and reduced production of ghrelin, a hormone that stimulates hunger.

Adjustable Gastric Banding: An adjustable band is placed around the stomach's upper part, creating a small stomach pouch above the band and the rest of the stomach below the band. The size of the opening between the two sections can be adjusted by filling or emptying the band.

Biliopancreatic Diversion with Duodenal Switch (BPD/DS): This complex procedure involves a sleeve gastrectomy and a rerouting of the small intestine. This surgery reduces the amount of food you can eat and reduces the absorption of nutrients.

Benefits and Risks

Bariatric surgery can offer significant health benefits, including substantial weight loss, improved cardiovascular health, and alleviation of conditions such as type 2 diabetes, obstructive sleep apnea, and certain types of cancer. However, these procedures are not without risks, such as surgical complications, nutritional deficiencies, and the necessity of lifelong dietary adjustments.

See also

• Obesity
• Body mass index
• Dieting
• Physical exercise
• Type 2 diabetes

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