ALL ABOUT WEIGHT LOSS SURGERY

How Weight Loss Surgery Works

Weight loss surgery works in two distinct ways: one approach restricts the amount of food that can be consumed at one time; the other alters digestion so that less food is absorbed. Both approaches are recognized by the American Society for Metabolic and Bariatric Surgery as effective. And they are powerful tools that have helped many patients lose weight and improve their health.

Laparoscopic Adjustable Gastric Banding (Lap Band) Surgery

This is a restrictive procedure that is performed laparoscopically. An adjustable silicone band (Lap-Band®) is placed around the upper part of the stomach, and then connected to an access port via the connector tubing. This port is secured to the abdominal wall. The port is deep under the skin and cannot be seen, but can sometimes be felt. After recovery from surgery, the port is accessed with a special needle and fluid is added or removed to tighten or loosen the band. Tightening the band creates a small stomach pouch above the band and that restricts the amount of food that can be eaten. Periodic adjustments are done in the office until only small meals can be eaten, appetite is reduced, and gradual weight loss is achieved.

Gastric Bypass Surgery

The gastric bypass procedure is a combination of restrictive and malabsorptive procedures. Although the surgery is laparoscopic, it is still considered major abdominal surgery. It involves permanent rearrangement of the gastrointestinal tract and causes weight loss by restricting the amount of food that can be eaten, and by limiting the amount of food that is absorbed. It is performed by stapling the stomach to create a small stomach pouch approximately 1-2 ounces in size to restrict the amount of food that one may eat. Then most of the stomach and part of the intestines are bypassed by attaching a part of the intestine to the new stomach pouch. Any food that is eaten bypasses the remaining stomach along with the first part of the small intestine, creating malabsorption.

Laparoscopic Adjustable Gastric Banding (Lap Band) Surgery Versus Gastric Bypass Surgery

Both procedures are powerful tools that patients may use to help lose weight and improve their health, but neither guarantees weight loss. Successful weight loss requires intense life-long efforts to adopt healthy eating habits and maintain a regular exercise program. With the proper motivation and significant lifestyle changes, many have found that weight loss surgery was the added help they needed to achieve their goals.

Laparoscopic Roux-en-Y Gastric Bypass

Laparoscopic Adjustable Gastric Banding (Lap-Band)

One of the big differences between the two procedures is the rate of weight loss.

• Lap band patients can expect to lose weight more gradually—with a goal rate of loss that is no more than 1-2 lbs per week. Weight loss after lap band surgery may continue for 2-4 years after surgery.

• Gastric bypass patients can expect rapid weight loss, especially within the first 3-6 months. Weight generally stabilizes between 12 and 18 months after surgery.

Laparoscopic Approach Versus Open Surgery

Laparoscopic surgery is a modern surgical technique used to perform operations through small incisions (usually 0.5-1.5cm), compared to larger incisions needed in traditional open surgery. This reduces pain, allows the patient to heal faster, and provides a lower risk for wound complications.

What Is Morbid Obesity?

Morbid obesity is typically defined as being 100 lbs. or more over ideal body weight or having a Body Mass Index of 40 or higher. Obesity results from the excessive accumulation of fat that exceeds the body's skeletal and physical standards. Today 97 million Americans—more than one-third of the adult population are overweight or obese. Obesity becomes "morbid" when it reaches the point of significantly increasing the risk of one or more obesity-related health conditions or serious diseases. An estimated 5 to 10 million Americans are considered morbidly obese. According to the National Institutes of Health Consensus Report, morbid obesity is a serious, chronic disease and must be treated as such.

What Are The Risks Associated With Morbid Obesity?

Here is a list of some of the common medical conditions related to morbid obesity:

• Type 2 Diabetes. Obese individuals develop a resistance to insulin, which regulates blood sugar levels. Over time, the resulting high blood sugar can cause serious damage to the body.
• High blood pressure/Heart disease. Excess body weight strains the ability of the heart to function properly. The resulting hypertension (high blood pressure) can result in strokes, as well as inflict significant heart and kidney damage.
  
• Osteoarthritis of weight-bearing joints. The additional weight placed on joints, particularly knees and hips, results in rapid wear and tear, along with pain caused by inflammation. Similarly, bones and muscles of the back are constantly strained, resulting in disk problems, pain and decreased mobility.
  
• Sleep apnea/Respiratory problems. Fat deposits in the tongue and neck can cause intermittent obstruction of the air passage. Because the obstruction is increased when sleeping on your back, you may find yourself waking frequently to reposition yourself. The resulting loss of sleep often results in daytime drowsiness and headaches.
  
• Gastroesophageal reflux/Heartburn. Acid belongs in the stomach and seldom causes any problem when it stays there. When acid escapes into the esophagus through a weak or overloaded valve at the top of the stomach, the result is called gastroesophageal reflux, and "heartburn" and acid indigestion are common symptoms. Approximately 10-15% of patients with even mild sporadic symptoms of heartburn will develop a condition called Barrett's esophagus, which is a pre-malignant change in the lining membrane of the esophagus, a cause of esophageal cancer.
  
• Depression. Seriously overweight persons face constant challenges to their emotions: repeated failure with dieting, disapproval from family and friends, sneers and remarks from strangers. They often experience discrimination at work, cannot fit comfortably in theatre seats, or ride in a bus or plane.
  
• Infertility. Excess weight can cause abnormal hormone signals, which negatively impact ovulation and sperm production.
  
• Urinary stress incontinence. A large, heavy abdomen and relaxation of the pelvic muscles, especially associated with the effects of childbirth, may cause the valve on the urinary bladder to be weakened, leading to leakage of urine with coughing, sneezing, or laughing.
  
• Menstrual irregularities. Morbidly obese individuals often experience disruptions of the menstrual cycle, including interruption of the menstrual cycle, abnormal menstrual flow and increased pain associated with the menstrual cycle.

Am I Morbidly Obese?

According to the NIH the medically accepted criteria for defining morbid obesity are:

• more than 100 lbs. over ideal body weight or
• a Body Mass Index (BMI) of over 40 with negative health effects, such as high blood pressure or diabetes
• inability to achieve a healthy body weight for a sustained period of time, even with medically supervised dieting

Use the BMI calculator to evaluate yourself. Additional tools for self-assessment are available through the National Heart Lung and Blood Institute. http://www.nhlbisupport.com/bmi/

Benefits Of Weight Loss Surgery

Above all, you will improve your health. For example, there is good evidence that weight loss surgery may significantly prolong the life of persons who have diabetes or other serious obesity-related health conditions, if they are at least 100 pounds overweight and if they are able to comply with lifestyle changes. Obesity surgery can make it easier to maintain long-term lifestyle changes because it helps to control your appetite. Weight loss can also improve your general sense of well being.

It's not easy to achieve these benefits because weight loss is a multi-faceted challenge. Here at Sibley in the DC metro area we have all the resources you need, in one place—surgeons, nutritionists, trainers, psychiatrists, administrators, insurance experts, labs and exercise facilities—so that you can achieve the weight loss you want.

The Importance of Support

The changes in your diet and lifestyle after surgery will last a lifetime. And you'll have a greater chance of long-term success if you surround yourself with people who understand and support your goals.

Things you can do:

• Help your friends and family members understand why you've chosen a surgical solution. Many people are under the impression that weight loss surgery is an experimental treatment rather than one with more than 40 years of history. Direct them to this web site or invite them to one of our information seminars. It's important that the people in your life understand that morbid obesity is a disease and that diets don't work for you.
  
  
• People who are morbidly obese often report that their spouses, or others close to them, seem to discourage weight loss. These people see your weight as part of your identity. Understand that this is a fear of change. Discuss your reasons for having surgery. They need to know that your health is at stake and you will be counting on them to help you during and after surgery.
  
  
• Take advantage of ongoing support groups like ours and surround yourself with people who understand and encourage you in your choice.

Life After Surgery

After your surgery you will be placed on a liquid diet for a short time, then started on "soft" foods and gradually transitioned to your new, life-long eating habits. We'll provide you with all the details and guidelines you'll need, and our team will support you on every step of your journey. Meals will be small, focusing on lean protein and vegetables. You'll need to eat slowly and take small bites, and drink 3-4 quarts of water and exercise daily.

Patients often report that they feel little appetite in the weeks following surgery. If patients follow the plan, they may achieve drastic weight loss which will gradually level off. The goal is not only to lose weight, but to keep it off. We supply the on-going support you will need—monitoring by our doctors, working with our nutritionist, regular exercise and support groups are all critical to your long-term weight loss success.