Often, those who are very
The surgery is low-risk but isn't for everyone. It requires a commitment to other lifestyle changes. But it can have many health benefits, according to Dr. Cynthia Long, advanced laparoscopic and bariatric surgeon at Sinai Hospital.
Can you describe the different types of bariatric surgery?
In general, there are three main categories of bariatric procedures. They include restrictive, malabsorptive and combination procedures. In restrictive procedures, the functional size of the stomach is markedly reduced. In malabsorptive procedures, ingested food bypasses segments of the intestine so that there is reduction in caloric intake. Finally, there are combination procedures, which employ both restrictive and malabsorptive methods to achieve
How common have the surgeries become?
The number of bariatric procedures has rapidly increased, from 6,868 in 1996 to 45,473 in 2001, and up to 220,000 per year were performed in the United States by 2008.
Who is the best candidate for each type of surgery?
There are basic clinical guidelines for patients based on their
Why do these procedures work when diet and exercise have failed?
The reasons are multifactorial. We know that there are certainly methods and degrees of weight loss that are within one's control, i.e. diet and exercise. Weight-loss efforts can often be stymied, though, by one's own physiological system that regulates weight similar to a thermostat controlling temperature. One's weight "set point" is genetically influenced, such that a decrease in body fat stores can cause a compensatory change in appetite and
Can the surgery help with diabetes, high blood pressure and other illnesses linked to obesity?
The salutary effects of this surgery on different medical conditions are truly impressive. There is improvement and resolution of many disease processes like type II diabetes, hypertension, obstructive sleep apnea, polycystic ovary syndrome and infertility, hypercholesterolemia, and osteoarthritis, just to name a few. Observational studies have shown between 55-95 percent remissions of type 2 diabetes mellitus with bariatric surgeries. These benefits are slightly more pronounced in the Roux-en-y gastric bypass procedure, which induces long-term control of type 2 diabetes by weight reduction, but also with alteration of gastrointestinal hormone secretion. About 79 percent of bariatric patients have improvement or resolution of high blood pressure and about 98 percent improve their hyperlipidemias.
What are the challenges or complications that could result?
Like any other abdominal surgeries, bariatric surgery is not without risk. In general, the risks associated with these procedures are less than the risks of obesity and obesity-associated co-morbidities. The loss of life expectancy due to obesity is profound in comparison with a normal-weight individual, a 25-year-old morbidly obese man has a 22 percent reduction in expected remaining life span, representing an approximate loss of 12 years of life. Certainly with the advent of minimally invasive techniques and designated centers of excellence, there are far fewer complications than has been seen in the past. The adjustable gastric band, a device approved by the