Saturday, August 15, 2009

What Is Bariatric Surgery?

If you are reading this blog, odds are you are interested in weight loss. You want to take charge of your life and be in control of your body. You want to eat to live, not live to eat. Many of us have struggled with the demons of weight loss and gain. There are fad diets, new exercises, all kinds of plans. Eventually, after you had considered all these options non-medical options, you may have considered what professional medicine had to offer for you. Perhaps you have heard of medications like Alli (Orlistat), a weight loss aid that helps control appetite. Still, you heard of even more radical options being offered: weight loss surgery. Specifically, bariatric surgery. And you wanted to know more.


What is bariatric surgery?

Weight loss surgery is often called bariatric surgery. These surgeries are performed on the gastrointestinal tract of patients who are morbidly obese, typically those with Body Mass Index > 40 who have failed other weight loss regimens. The most common procedures are the gastric bypass (also known as a Roux-en-Y procedure) and gastric banding (sometimes referred to as "lap banding" because it is done laparoscopically). According to the Mayo Clinic:
Weight-loss (bariatric) surgery changes the anatomy of your digestive system to limit the amount of food you can eat and digest. The surgery aids in weight loss and lowers your risk of medical problems associated with obesity.

Gastric bypass is the favored bariatric surgery in the United States. Surgeons prefer this surgery because it's safer and has fewer complications than other available weight-loss surgeries. It can provide long-term, consistent weight loss if accompanied with ongoing behavior changes.

Gastric bypass isn't for everyone with obesity, however. It's a major procedure that poses significant risks and side effects and requires permanent changes in your lifestyle. Before deciding to go forward with the surgery, it's important to understand what's involved and what lifestyle changes you must make. In large part, the success of the surgery is up to you.
The key sentence from the Mayo clinic is: In large part, the success of the surgery is up to you.

What this means is that as a patient, it is your responsibility to educate yourself about how bariatric surgery works and what you can do before and after the procedure to ensure that it is a success. Remember, bariatric surgery is not a magical cure for obesity. In some ways, it is an extreme measure taken for people who are unable to lose weight by any other means. People can, and have, gained back all the weight they lost after bariatric surgery by not being full committed. The key is commitment.


How does bariatric surgery lead to weight loss?

In general, the procedures work by limiting either the amount of volume/space available for digestion within the GI tract, the amount of digestive/absorptive capacity of the GI tract, or both. Future posts will go into greater detail about particular procedures, but this is the basic principle underlying bariatric procedures. A simplified view of the gastrointestinal tract makes it clear why bariatric surgery is effective weight loss surgery.

After food enters the mouth, it begins the process of digestion. It travels down the esophagus to the stomach, where it undergoes further breakdown. The food then passes from the stomach into the small intestine, where it begins to be absorbed. A majority of nutrient absorption occurs here, prior to the food being expelled into the large intestine. The large bowel is primarily involved in absorbing water from food and then excreting the by-product.

By reducing the size of the stomach, bariatric surgery mechanically reduces how much one can take in as nutrition. By removing part of the small intestine, bariatric surgery can also decrease how much is absorbed into the body. After the procedure, food that used to be fully absorbed is now partially absorbed, with the leftover being excreted via the colon.

Stay tuned for future posts that go into detail about these procedures, the pros/cons, and the key information you need to make your surgery a success.

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