Diabetes & The Body

Surgical Options for Weight Loss

Many obese people fail diet after diet. For them, surgery can be another option. Although bariatric surgery can be risky, it can also help people live healthier lives.

When a person is significantly over weight, and every diet he or she tries fails, another option may be surgery. The benefits of surgery can be quite dramatic. In terms of weight loss, we anticipate that patients lose about 70 percent of their excess body weight in one to two years. Among my patients, who on average weigh 390 pounds before surgery, on average they lose 135 pounds in a year.

It's called bariatric surgery. And it's much more sophisticated than intestinal bypass surgeries that were pioneered two generations ago.

There are two general principles by which surgery for obesity works. One is by decreasing the capacity of the stomach. So this portion of the stomach that food gets into is much smaller, the patient feels full quicker, and so they eat less calories. The second general mechanism is malabsorption; that is, bypassing a segment of intestine to the point that you don't absorb all of the calories that you're eating.

Surgery for weight loss

Surgery for weight loss is not for everybody. In fact, the only candidates are people who have really tried hard by other means, and failed.

One of the criteria, a sort of nationally accepted criteria, is that patients have to have been through some form of organized weight loss program in the past and failed to maintain that weight loss.

And the degree of obesity must be significant.

If you take a person who is five foot, six inches tall, they might have to weigh something in the neighborhood of 260 pounds or more in order to qualify for surgery.

Bariatric surgery is major surgery, and it carries risk.

Overall, the risk of dying is probably in the neighborhood of 1% within the first month or two after surgery. Usually that occurs from one of three causes: a heart attack; a blood clot in the legs which travels up to the lungs, otherwise known as a pulmonary embolism; and a leak at the connection between the stomach and small intestine.

Less serious complications can occur too. These can include infection, hernias, bowel obstructions, and internal bleeding. Some of these problems have become less frequent as more doctors perform bariatric surgery with less invasive, laparoscopic techniques.

Even when the surgery goes as expected, patients may experience nausea or diarrhea. And they must realize that not all of their initial weight loss will likely be permanent.

Well, the best data that we have comes from a series of patients done in North Carolina, and that demonstrates that patients maintain loss of 55 percent of their initial excess body weight even up to 15 years after the surgery. So they do regain a small amount over those first two to five years after the operation, but then they tend to plateau and stay at their lower weight.

Finally, some of the benefits of weight loss surgery are only indirectly linked to excess weight.

In patients who are diabetic, two-thirds of those patients come off of all their diabetes medicine and have normal blood sugars. Half the patients that are taking high blood pressure medicine come off of all their high blood pressure medications, and another quarter of patients have a reduction in the dosage or the number of medicines that they take for high blood pressure.

Surgery for weight loss is a big step for people who are overweight. And it's not without risk. But for many people with significant weight problems who have failed with less dramatic techniques, surgery offers another chance to succeed.