How Does Weight Loss Surgery Work?
The concept of gastric surgery to control obesity grew out of results of operations for cancer or severe ulcers that removed large portions of the stomach or small intestine.
Because patients undergoing these procedures tended to lose weight after surgery, some doctors began to use such operations to treat severe obesity. The first operation that was widely used for severe obesity was a type of intestinal bypass. This operation, first used 40 years ago, caused weight loss through malabsorption (decreased ability to absorb nutrients from food because the intestines were removed or bypassed).
The idea was that patients could eat large amounts of food, which would be poorly digested or passed along too fast for the body to absorb many calories. The problem with this surgery was that it caused a loss of essential nutrients (malnutrition) and its side effects were unpredictable and sometimes fatal. The original form of the intestinal bypass operation is no longer used.
Surgeons now use other techniques that produce weight loss primarily by limiting how much the stomach can hold. Two types of surgical procedures used to promote weight loss are:
Restrictive surgery: During these procedures the stomach is made smaller. A section of your stomach is removed or closed, which limits the amount of food it can hold and causes you to feel full.
Malabsorptive surgery: Most of digestion and absorption takes place in the small intestine. Surgery to this area shortens the length of the small intestine and/or changes where it connects to the stomach, limiting the amount of food that is completely digested or absorbed (causing malabsorption). These surgeries are now performed along with restrictive surgery.
Through food intake restriction, malabsorption, or a combination of both, you can lose weight since less food either goes into your stomach or stays in your small intestine long enough to be digested and absorbed.
Benefits and Risks of Weight Loss Surgery
Weight loss surgery is a serious undertaking. Before making a decision, talk to your doctor about the following benefits and risks.
Benefits
Weight loss: Immediately following surgery, most patients lose weight rapidly and continue to do so until 18 to 24 months after the procedure. Although most patients then start to regain some of their lost weight, few regain it all.
Obesity-related conditions improve: For example, recent research has shown that in obese patients with diabetes, bariatric surgery resulted in better blood sugar control than medication. This held true no matter what the person weighed before surgery, or how much weight they were able to lose.
Risks and Side Effects
Vomiting: This is a common risk of restrictive surgery caused by the small stomach being overly stretched by food particles that have not been chewed well.
"Dumping syndrome": Caused by malabsorptive surgery, this is when stomach contents move too rapidly through the small intestine. Symptoms include nausea, weakness, sweating, faintness and, occasionally, diarrhea after eating, as well as the inability to eat sweets without becoming extremely weak.
Nutritional deficiencies: Patients who have weight loss surgery may develop nutritional deficiencies such as anemia, osteoporosis, and metabolic bone disease. These deficiencies can be avoided if vitamin and mineral intakes are maintained.
Complications: Some patients who have weight loss operations require follow-up operations to correct complications. Complications can include abdominal hernias, infections, breakdown of the staple line (used to make the stomach smaller), and stretched stomach outlets (when the stomach returns to its normal size).
Gallstones: More than 1/3 of obese patients who have gastric surgery develop gallstones. Gallstones are clumps of cholesterol and other matter that form in the gallbladder. During rapid or substantial weight loss a person's risk of developing gallstones increases. Sometimes this can be prevented by taking supplemental bile salts for the first 6 months after surgery.
Need to temporarily avoid pregnancy: Women of childbearing age should avoid pregnancy until their weight becomes stable because rapid weight loss and nutritional deficiencies can harm a developing fetus.
Side effects: These include nausea, vomiting, bloating, diarrhea, excessive sweating, increased gas, and dizziness.
Lifestyle changes: Patients with extensive bypasses of the normal digestive process require not only close monitoring, but also life-long diet and exercise modifications and vitamin and mineral supplementation.
Because patients undergoing these procedures tended to lose weight after surgery, some doctors began to use such operations to treat severe obesity. The first operation that was widely used for severe obesity was a type of intestinal bypass. This operation, first used 40 years ago, caused weight loss through malabsorption (decreased ability to absorb nutrients from food because the intestines were removed or bypassed).
The idea was that patients could eat large amounts of food, which would be poorly digested or passed along too fast for the body to absorb many calories. The problem with this surgery was that it caused a loss of essential nutrients (malnutrition) and its side effects were unpredictable and sometimes fatal. The original form of the intestinal bypass operation is no longer used.
Surgeons now use other techniques that produce weight loss primarily by limiting how much the stomach can hold. Two types of surgical procedures used to promote weight loss are:
Restrictive surgery: During these procedures the stomach is made smaller. A section of your stomach is removed or closed, which limits the amount of food it can hold and causes you to feel full.
Malabsorptive surgery: Most of digestion and absorption takes place in the small intestine. Surgery to this area shortens the length of the small intestine and/or changes where it connects to the stomach, limiting the amount of food that is completely digested or absorbed (causing malabsorption). These surgeries are now performed along with restrictive surgery.
Through food intake restriction, malabsorption, or a combination of both, you can lose weight since less food either goes into your stomach or stays in your small intestine long enough to be digested and absorbed.
Benefits and Risks of Weight Loss Surgery
Weight loss surgery is a serious undertaking. Before making a decision, talk to your doctor about the following benefits and risks.
Benefits
Weight loss: Immediately following surgery, most patients lose weight rapidly and continue to do so until 18 to 24 months after the procedure. Although most patients then start to regain some of their lost weight, few regain it all.
Obesity-related conditions improve: For example, recent research has shown that in obese patients with diabetes, bariatric surgery resulted in better blood sugar control than medication. This held true no matter what the person weighed before surgery, or how much weight they were able to lose.
Risks and Side Effects
Vomiting: This is a common risk of restrictive surgery caused by the small stomach being overly stretched by food particles that have not been chewed well.
"Dumping syndrome": Caused by malabsorptive surgery, this is when stomach contents move too rapidly through the small intestine. Symptoms include nausea, weakness, sweating, faintness and, occasionally, diarrhea after eating, as well as the inability to eat sweets without becoming extremely weak.
Nutritional deficiencies: Patients who have weight loss surgery may develop nutritional deficiencies such as anemia, osteoporosis, and metabolic bone disease. These deficiencies can be avoided if vitamin and mineral intakes are maintained.
Complications: Some patients who have weight loss operations require follow-up operations to correct complications. Complications can include abdominal hernias, infections, breakdown of the staple line (used to make the stomach smaller), and stretched stomach outlets (when the stomach returns to its normal size).
Gallstones: More than 1/3 of obese patients who have gastric surgery develop gallstones. Gallstones are clumps of cholesterol and other matter that form in the gallbladder. During rapid or substantial weight loss a person's risk of developing gallstones increases. Sometimes this can be prevented by taking supplemental bile salts for the first 6 months after surgery.
Need to temporarily avoid pregnancy: Women of childbearing age should avoid pregnancy until their weight becomes stable because rapid weight loss and nutritional deficiencies can harm a developing fetus.
Side effects: These include nausea, vomiting, bloating, diarrhea, excessive sweating, increased gas, and dizziness.
Lifestyle changes: Patients with extensive bypasses of the normal digestive process require not only close monitoring, but also life-long diet and exercise modifications and vitamin and mineral supplementation.
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