Many Americans struggle with their weight. Data from the National Health and Nutrition Examination Survey, 2009-2010 showed that more than two out of three Americans were overweight or obese and one out of three was obese.
The most commonly-used tool to gauge if someone is overweight or obese is the Body Mass Index (BMI) Calculator. BMI is calculated by taking into account our height and weight. For adults, a BMI of 18.5 to 24.9 is within the normal range, 25 – 29.9 is overweight and 30 – 39.9 is obesity. A BMI of 40 or greater is considered extreme obesity.
Being overweight increases risk for a number of diseases. These include:
Type 2 diabetes
High blood pressure (hypertension)
“Obesity can cause a myriad of chronic health conditions, deplete energy levels and negatively affect both self-esteem and confidence,” says Dr. Jeremy Parcells, a bariatric surgeon. “It’s a serious health condition that requires treatment.”
The fundamental reason for weight gain is that we consume more calories than we burn. Eating a healthy, balanced diet and getting enough exercise are two of the most effective ways to manage our weight.
Other factors can also contribute to weight gain, however. Genetics play a role for some people, as does metabolism. An underlying health condition, such as arthritis or diabetes, which inhibits one’s ability to engage in physical activity, can also be a factor.
“There’s no doubt that most people are able to lose weight through diet and exercise, and those are likely the first things your physician would recommend to help you lose weight,” says Dr. Antonio Castaneda, a general surgeon. “However, some folks may require additional help. For some people with medical conditions such as diabetes, sleep apnea and hypertension, bariatric surgery may be an option."
Types of Bariatric Surgery
According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), candidates for bariatric surgery have a BMI of 35 or higher. For individuals in this category, diet and exercise alone are often insufficient to create the amount of weight loss necessary to achieve a healthy BMI.
“Your doctor will help you decide if bariatric surgery is right for you and if it is, which procedure will give you the best outcome,” says Dr. Parcells. “For bariatric surgery to be truly successful, the patient has to commit to a healthy lifestyle going forward.”
Bariatric surgery is often done laparoscopically, meaning the surgeon makes several small incisions and inserts small surgical tools through the cuts to perform the procedure. The surgeon is aided by a small camera, which is also inserted into one of the incisions. There are three major types of bariatric surgery:
Gastric Band: The gastric band is a ring with an inflatable band which is placed around the top of the stomach, creating a pouch. The result of this procedure is the patient feels full after eating only a small amount of food. The inflatable band is filled with a saline solution, the size of which the physician can adjust periodically, depending on the patient’s specific needs. This procedure requires several post-surgery visits to the doctor for adjustments to the band. Unlike the other two major weight-loss surgeries, gastric band is approved by the Food and Drug Administration for patients with a BMI of 30 and greater who also have a chronic health condition, such as diabetes.
Gastric Sleeve: In gastric sleeve surgery, the physician removes most of the patient’s stomach. The smaller stomach that remains holds much less food, resulting in the patient feeling full much quicker and consuming fewer calories.
Gastric Bypass: Gastric bypass surgery consists of two steps. First, the stomach is stapled at the top, creating a small pouch that leads to eating less and feeling full quickly. The second element of gastric bypass is that the small intestine is cut and attached directly to the small stomach pouch. The bypassed section of the stomach is connected to the lower part of the small intestine. The result of this procedure is that the body absorbs fewer calories – since the food bypasses most of the stomach and much of the small intestine, there is less opportunity for calorie absorption.
There are pros and cons with each surgery option. Gastric band is reversible but leads to less weight loss than the other two surgeries. It may also require a future surgery to replace the band. Gastric sleeve creates greater weight loss than gastric band, but is not reversible. It may also lead to deficiencies in vitamins and minerals. Gastric bypass creates the greatest weight loss but also the greatest chance of a vitamin deficiency. It is also difficult to reverse.
Before and After Surgery
In addition to extensive consultation with a bariatric surgeon, a patient will also visit with a dietician. The dietician will explain which foods to eat and which to avoid before and after surgery, as well as discuss how eating will be different after the surgery is completed.
Patients are usually advised to begin eating healthier and engaging in a more active lifestyle, if possible, before surgery – this can aid in the surgery recovery, as well as help lay the groundwork for a continued healthy lifestyle after surgery.
Following surgery, a patient may be prescribed supplements to ensure sufficient vitamin intake. Patients generally start out with liquids and then move to soft foods. There will be certain foods your doctor and dietician advise you to eat and others you are to stay away from. All food must be eaten slowly and chewed well.
What Are the Results?
The amount of weight lost will depend on the patient – results are not identical in all cases. On average though, the NIDDK reports that patients who have had the gastric band surgery lost an average of 45 pounds after three years and those who had the gastric bypass lost an average of 90 pounds over the same period of time. Results for gastric sleeve surgery appear to be similar to those of gastric band.
“In my practice, in regards to bariatric surgery, the most common regret a patient expresses to me is, ‘I wish I had done this sooner,’” says Dr. Parcells.
Healthy Lifestyle is Key
No surgery is a substitute for a healthy lifestyle. Eating a healthy, balanced diet and getting enough exercise are two keys to maintaining a healthy body weight, as well as promoting numerous other health benefits. This is true for everyone, including those who have had bariatric surgery.
“Bariatric surgery gives the patient an opportunity to improve their medical conditions as they lose their excess weight, but it’s not a cure-all,” says Dr. Castaneda. “The patient has to be committed to a healthy lifestyle and work to maintain it after weight-loss surgery. For patients willing to do those things, it can truly transform their lives.”
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