Have you been considering bariatric surgery to aid in your weight loss efforts? Then there are a few things you should know… So first of all, Why bariatric surgery? Currently, weight loss surgery is the most effective and sustainable treatment option for severe obesity as long as the individual is motivated to make the lifestyle changes required. Obesity is a major health problem because of its serious health consequences including: increased mortality risk, and associated social, psychological and economic costs.
Presently, bariatric surgery is the only available treatment for morbidly obese individuals that consistently achieves and maintains substantial weight loss, decreases the incidence and severity of obesity-related comorbidities, and improves overall quality and length of life. Who is a candidate? Based on the National Institutes of Health, individuals with a BMI greater than 40 or 35 if obesity related health issues exist. If an individual has a BMI of as low as 30 and currently has diabetes, that person is also a candidate.
Individuals who are psychologically stable and able to make diet and exercise changes to achieve long-term success after surgery are candidates. Lastly, individuals must have previously tried and failed other weight loss regimens. What types of Bariatric surgery are there? There are several options for you: Gastric bypass is the most common in the United States. It restricts food intake, promotes selective malabsorption, and the development of dumping syndrome, which is set off by simple sugars. This trains the body to eat certain foods and stay away from others.
Gastric bypass has a weight loss average of 65% for most patients with over 85% of patients losing and maintaining 50% initial excess weight loss. Mortality rates are approximately 0. 1% and serious early complication rates are 5%. Long-term issues with fat malabsorption, protein-energy malnutrition and micronutrient deficiencies are relatively uncommon and can usually be managed with oral supplementation. Adjustable gastric band is the least invasive and most commonly performed bariatric operation world-wide. This band is adjustable and the only type of surgery that may be reversed.
The non-permanancy makes it the main target for adolescent obesity. There is a low risk of mortality, and long-term complications are uncommon. There is a 35% initial excess weight loss on average by most patients; however, there are high failure rates and high reintervention rates. About half of patients may have their band in place after 10 years. The gastric sleeve is the newest and most popular for surgeons because it is less surgically invasive and quicker than the bypass and gives better results. There aren’t many well-documented statistics because it is newly popular.
The last type of surgery is a gastric diversion which is the most uncommon procedure elected for because the risks outweigh the benefits. Now that you’ve heard about the different options, How can you decide between each? The decision to perform one bariatric procedure over another depends on the surgeon’s experience, patient’s weight, reliability and compliance with lifestyle modifications and follow-up. The decision is based on the biases and abilities of the surgeon and patient’s preference and acceptance of risks. It is important to understand the amount of weight loss possible and the potential risks after surgery.
Which one is the most preferred? The adjustable gastric band is least likely to cause problems followed by the gastric sleeve, gastric bypass and gastric diversion. The gastric bypass is the most common and most preferred for morbidly obese patients; this preference is due to the “dumping syndrome” that is encountered by patients that consume excessive sweets or high caloric, simple sugar foods. It should be noted that this option is the most likely to create nutrient deficiencies. The diversion is typically used for extremely obese patients with a BMI over 50.
The gastric band is the least invasive weight loss surgery and can be reversed if necessary, which is the main preference for obese adolescents. So what are the pros of bariatric surgery? Some of the pros include: the Initial and sustained weight loss, resolution of obesity related health outcomes, and improved mortality. Reduction in obesity related health risks, and improved quality of life are also benefits. That sounds great. But what are the cons?
The cons are the initial costs involved, initial failure to lose weight, and a variety of complications including nutritional, G. I., surgical and psychological issues. There is potential need for re-operation from weight regain or the body not accepting the surgery. Women in reproductive age will be at risk for vitamin deficiencies. After surgery, iron deficiencies and anemia may occur in a higher percentage of patients, mainly as a consequence of this nutritional deficiency. Lastly, the long-term consequences requiring lifelong monitoring and medical care are also a major con considering the permanency of the operation. Bariatric surgery is not a cure for obesity, nor is it the solution to the epidemic of obesity.
It is only a head start to a help obese people to be healthier and change their life style. It helps those who have failed to resolve obesity related health problems using other interventions. What are the main concerns with nutritional deficiency? The reduced calorie intake of about 700-900 calories per day can cause severe malnutrition in the first 6 months after the operation. This decreases all nutrients. The most important concern is inability to consume protein to meet needs. This is a major problem since protein deficiency contributes to hair loss and poor wound healing, which is not good for a post operative patient who needs to heal.
Anemia is a major concern in one third of patients; it can also be exacerbated by chronic inflammation from obesity. Vitamin D and calcium are also major micronutrient deficiencies after surgery. Vitamin D deficiency may contribute to dysfunction of the innate immune system, and therefore play a role in increasing risk of cancers, diabetes mellitus, and heart disease. Fat soluble vitamin deficiencies, specifically vitamins A,E, and K, are also very common due to fat malabsorption. What about Pregnancy after surgery?
The importance of routine nutritional screening and supplementation is heightened in pregnancy following bariatric surgery. In general, pregnancy after bariatric surgery appears to be very safe after the rapid weight loss phase has ended and a stable weight has been achieved. Anemia is the most common problem during pregnancy after bariatric surgery. Rare but severe fetal and maternal complications due to nutrient deficiencies have been reported. Birth weight and the risk of Macrosomia (or an infant weighing more than 10 pounds at birth) increases with higher BMIs.
Though the weight loss associated with bariatric surgery reduces birth weight and the risk for Macrosomia, lower consumption of calories and the malabsorption resulting from the operation may contribute to maternal malnutrition. This could potentially bringing about adverse effects on fetal growth. The majority of women, even after going through bariatric surgery, are still overweight or even obese, though less than so before. Nutritional deficiencies are frequently encountered in patients who have undergone some type of bariatric surgery, but these can amplified during pregnancy.
Absorption of vitamin B12 is affected by bariatric surgery, since a part of the stomach is surgically removed. Even with oral supplementation of B12, nutritional deficiency may still exist, and periodic monitoring of these levels is crucial. Hopefully, now you have some more information on bariatric surgery: the good, the bad, and the ugly. For many, the success rate is high, and bariatric surgery was a vital tool in achieving sustained weight loss. There are also some risk factors to consider. Ultimately, the choice is yours.