Weight-loss surgery: it’s not for everyone.
Weight-loss surgery, also known as gastric bypass surgery, has increased tenfold over the past decade, with more than 150,000 americans undergoing surgery each year. Most insurance companies and health insurance companies pay for it. Most patients have successful outcomes, but there are still significant risks, and surgery is not for everyone.
Dr. Paul Shekelle directs the rand corporation’s evidence-based practice center. He said there was no doubt that gastric bypass surgery was “effective”. The average patient lost an average of 100 pounds or more in a year. They also reduce the risk of obesity-related diseases such as high blood pressure, diabetes and high cholesterol.
But Shekelle worries that surgery is too attractive for patients who don’t need surgery. For the unskilled surgeons.
“It’s in our own newspaper, you can open it, there’s an AD for a weight-loss surgery, so it’s a direct sale to the public, and the AD usually asks,” are you overweight? Have you tried everything? Consider our obesity surgery center.
Not all surgical centers are equal.
But not all weight-loss surgery centers are equal, Shekelle said. Some people have better results than others. These results are important because the complications may be important as Dr. Ed Livingston is director of gastrointestinal surgery at the university of Texas southwestern medical school. He said he had been undergoing gastric bypass surgery for the past 13 years and that for most patients, his operation was very good. In fact, when he first started the operation, he was surprised by what he called the “amazing” results. Patients, he said, were very positive about the results, even “euphoric.”
But you have to remember that this is an operation, livingston warned. There could be problems. A major complication, he said, was the leak.
“We put all these pieces together and if the contents of the intestine leak into the abdomen, people get infected,” livingston said. “They have a very, very difficult time. They can sleep for a few months.”
One in 200 patients died from surgery. Blood clots can occur in the legs or lungs. They may have a hernia at the incision site, and “dump” syndrome, if they eat foods high in fat or sugar that can cause physical discomfort, nausea and sweating.
“Patients undergoing gastric bypass surgery must know that their bodies are undergoing permanent changes in the way they absorb food,” Shekelle said. “This means that they can expand and gas with certain foods, and because the food is not fully absorbed, the patient may lack certain nutrients and vitamins.
It’s not a dietary supplement.
While bypass surgery may be the right answer for some seriously obese people, it’s clearly not for everyone. Those over 55, such as high blood pressure and diabetes, are more at risk.
Shekelle also worries that people with lower body mass index, based on height and weight, may want surgery.
“Initially, BMI was over 40,” Shekelle said. “So BMI is more than 35. Before long, people were not overweight, they wanted surgery instead of dieting, he said.
Unfortunately, Shekelle says there may be an operation center or doctor willing to help them do so. Obesity experts are now trying to figure out how to evaluate from a variety of surgical centers, hospitals and doctors as a result, in order to open this information, and help patients to decide the position of the operation, if you decide they will be fit for the operation.
What is the most effective type of bariatric surgery? How do you know you’re a good candidate? Can you eventually regain your weight? Dr. Ed Livingston, a professor of surgery at the university of Texas southwestern medical center, responded to our report on gastric bypass surgery and other queries.
What is the most successful gastric bypass operation? I have scheduled surgery on October 12, 2006, and offered three options: laparoscopy, laparoscopic assisted surgery, and open surgery. [editor’s note: these three methods are exposed to the stomach in order to rebuild.] I chose a laparoscopic hand assist.
I was worried about the first three months after the operation. What is the best resource for selecting and preparing food? – Michele DiQuattro, Quakertown, Pa.
The effectiveness of the operation comes from the final reconstruction of the stomach and small intestine, not the practice. Roux-en-Y gastric bypass – named after the design technique and the “Y” shape of the small intestine reconstruction, is the safest and most effective operation. In terms of weight loss and the control of medical complications, the results were the same as those from open surgery and laparoscopic surgery from a 6-inch incision. Even surgical complications are not so different: laparoscopic surgery can avoid complications and laparoscopic gastric bypass surgery is more common.
For the second part of your question, I suggest looking for a dietitian – your surgeon should have a suggestion – and talk to other patients who have already done so.
Can laparoscopy regulate the gastric band (” strap “) as well as gastric bypass surgery? I was told that this was effective, and that there was a shorter recuperation than bypass surgery. – Michael Travis, warren, mich.
Postoperative recovery is easier – placing an inflatable zone around your belly to limit your intake. The pull, however, may not be so effective. The belt needs a lot of patient compliance and access to the doctor. With gastric bypass surgery, most people lose weight no matter what they do, because the postoperative physiological response makes them sick if they eat fat. Because of the gastric band, patients can still eat fatty foods, so a large number of patients are required to buy. The band is slow to lose weight, and it may take five years for the band to be able to lose weight after a year of bypass.
Is surgery reversible? – lauren Paul, California.
Roux-en-y gastric bypass surgery should not be considered reversible. The part of the stomach and the small intestine can be put together again, but their function will never be the same. In these operations, important nerves that regulate gastric function are likely to be cut off.
The straps can be reversed by removing them. There are no consequences.
My concern is that if I decide to have surgery, I may regain my weight. I read some places where I might have an initial weight gain of 10 to 30 percent. Is it possible to get a 100% return? -elaine Moheet, Sheldon, Connecticut.
This can happen, but not often. After gastric bypass surgery, the patient usually reaches the minimum weight within one year after surgery. Between the ages of 1 and 5, the weight will be restored, but the patient’s weight will stabilize after 5 years. The long-term results of lap segments in the United States are unclear.
What is the long-term problem of roux-en-y gastric bypass surgery? I’ve heard that the absorption of nutrients has decreased. – Barbara Kinback in Jackson lake, Texas.
The reduction of nutrition absorption after roux-en-y gastric bypass is quite small. The main problems are iron and vitamin B12. These are poorly absorbed and need to be replenished. Calcium absorption decreases and needs to be replenished. Primary care physicians should conduct annual reviews of basic nutritional measures.
I’m interested in hearing about ghrelin in the news coverage of bariatric surgery. A few years ago, I had read this appetite hormone. Is there any research that is regulating weight through ghrelin? – Wendy Smith, camp hill, Pennsylvania.
Auxin release peptide is a hormone secreted by the stomach to induce appetite. It is very inconsistent to study whether auxin release peptides are affected by gastric bypass surgery. According to the available information, no one can conclude that auxin release peptide participates in the gastric bypass effect. The exact mechanism of the gastric bypass is still unknown.
There is research into ghrelin and many other substances as potential obesity treatments. Unfortunately, there is no indication yet.
Drug development for obesity treatment has proved frustrating. Diet is essential for survival. As a result, animals have evolved redundant mechanisms to ensure they find and consume food. When a drug blocks a pathway, there seems to be another way to get rid of it. Of the roughly 200 drugs developed for obesity treatment, it appears to have a relatively modest short-term weight loss effect.
Does the stomach stretch again over time, or does it remain at 1/2 ounce? – Andrew long, Columbia, Pa.
Over time, the spread of the stomach may occur. No one clearly recorded that this really happened. It is understood that weight loss has nothing to do with the size of the pouch or the size of the connection between the stomach and the small intestine. It has been clearly shown that reducing the size of a large bag or making the connection smaller will not lead to further weight loss.
One in 200? That sounds like a huge number for elective surgery. Is this a typo? – kyle Robins, New York, Rome.
The death rate from obesity surgery ranged from 0.2% to 1.8%. This involves the risk of complications. The operation of obese people is inherently high-risk. Many of the complications associated with postoperative mortality were not associated with obesity surgery; Instead, they are a function of obesity. For example, one of the most common causes of postoperative death is pulmonary embolism – blood clots in the lungs. These can occur in obese patients with any type of surgery.
The risk varies from patient to patient. Very large elderly men have a higher risk of complications than relatively healthy young women.
Although the percentage seems high at 20 percent or 0.5 percent, the 5 percent mortality rate after heart surgery is not uncommon.
Should gastric bypass surgery be prescribed by a doctor who does not perform the operation and will be referred to others? I’m concerned that the first person to perform such a procedure would automatically lead to surgery, even if it might not be the right person. Darlene Whitten of Denton, Texas.
There is no guarantee of your doctor’s prejudice. Some non-travellers are totally opposed to these procedures and are unaware of any potential benefits. On the other hand, non-surgeons refer patients to the operation and do not know the patient’s risk.
Yes, some surgeons may actively recruit patients. However, others may be very conservative in accepting patients because of the inexperience of previous weight-loss surgery complications.
The best way is to find a doctor who has no financial benefit during the operation. This may prove difficult, but such surgeons can be found in large HMO or group practices in academic medical centers and in government hospitals such as VA. Another way is to get multiple opinions.
I wonder if there is some sort of evaluation procedure/certification for the doctor’s ranking. So how do you evaluate the results of a particular surgeon/clinic? Based on weight loss, the number of infections, the number of deaths, or some other criteria, is this the norm? Does anyone assess the quality of surgical specialists and clinics in this field, and if so, can they be provided to the public? – Brian Chabowski, east Lansing, Michigan.
Quality is an elusive concept. It is difficult to know the quality of the plan or its surgeon. Quality or complication rates or mortality cannot be assessed, as high quality projects may also be selected to take care of the highest risk patients. There are measures to try to measure the quality of care for weight loss surgery, but none has been tested, and there is no reliable way to do so. No one really knows how to evaluate the quality of care for weight-loss surgery.
High quality surgeons are likely to be those who have performed hundreds of gastric bypass operations. They should be open and willing to discuss their results, both good and bad.
The most knowledgeable person about a weight-loss surgeon is a nurse who works in an operating room. You can also ask your trusted doctor. Talk to your physician. A physician might say, “I’ve sent the patient to a doctor who did a good job or did a bad job.” Surgeons who do not operate themselves may also know that they are likely to take care of the complications of bypass surgeons who are not very good at these operations.
What is the position of the American college of obstetricians and gynecologists (ACOG) and the American society for weight loss surgery on gastric bypass surgery and pregnancy? How much data have been collected on pregnancy complications and gastric bypass surgery and ligation bands? Pamela Anderson, Lexington, ky.
I can’t say these organizations, but women should not be pregnant in the first year after bariatric surgery. After that, pregnancy is not a problem, but it requires close nutrition monitoring. There’s some data about pregnancy, but not a lot. There are indications that, in the case of obesity, the weight loss caused by surgery is safer than pregnancy.
What is the recommended way for people over 35 to try to change their habits if they only recommend weight-loss surgery for people with a BMI above 40? – Gabriel Waxemberg, Sylvania, Ohio.
Current recommendations allow for weight loss surgery, if there are significant obesity related medical conditions for people with a BMI of 35 to 40. I’ve seen a significant number of patients who have undergone surgery in this weight category to develop a significant amount of weight loss. More research is needed to give recommendations on the safety/effectiveness of patients with BMI <40.