Weight Loss Surgery, Part 2

Fat Chance

In part one last week, we basically outlined the different kinds of bariatric surgery. But do they work, and how well? Thanks to WebMD, any morbidly obese person who is considering such an operation can get a basic idea of what to expect. Adjustable gastric banding, for instance, is less invasive than some surgeries, but the weight loss effects might also be less dramatic. These patients also seem to regain weight more readily, later on.

The sleeve gastrectomy, when performed on a patient with a high body mass index, will probably result in a loss of around half the excess weight within three years. In other words, if the person started out 100 pounds overweight, he or she could expect to lose 50 pounds over three years. The gastric bypass or Roux-en-Y procedure gives “swift and dramatic” results, with most of the loss happening in the first six months. The patient will probably continue to lose weight for a couple of years, and likely maintain the loss for ten years or more. According to WebMD:

Because of the rapid weight loss, health conditions affected by obesity — like diabetes, high blood pressure, high cholesterol, arthritis, sleep apnea, heartburn, and other conditions — often improve quickly. You’ll probably also feel a dramatic improvement in your quality of life.

Then there is biliopancreatic diversion, which may lead to even greater weight loss at a faster rate than the gastric bypass. The patient might shed as much as 80% of the excess weight. Are there risks? You bet, even with laparoscopic procedures. Same as with any open surgery, infection is a risk when the integrity of the skin is broached. WebMD lists the possible risks and side effects of gastric banding. Although minimally invasive, it also holds dangers:

* Band slippage
* The passageway created by the band can be blocked by food
* Access port leakage or infection
* Esophagitis or gastroesophageal reflux disease (GERD)
* Malnutrition

Vomiting is also a possible side effect of gastric banding or “lap band” surgery, a consequence of the person eating too much, too fast. The tummy can now hold only ¼ cup of substance! You especially don’t want to vomit during the immediate post-op phase, during the couple weeks of liquid diet, or the couple more weeks of baby-food diet. After a month, it’s tender cooked foods, very well chewed. And no more popcorn, nuts, or seeds, ever again.

WebMD‘s slide show, “What to Expect with Weight Loss Surgery,” also mentions (in addition to those already mentioned) more possible negative consequences of bariatric surgery. The newly created little pouch could stretch back to the stomach’s original size. The band could disintegrate, or the staples could come loose, and stomach contents could leak into parts of the anatomy where they are not supposed to be.

Here, courtesy of the University of California’s Dr. Santiago Horgan, are the life-long rules to be followed by the person with a lap band. Of course, if a person could follow these rules, she or he probably would never have become obese in the first place. But maybe the big head start given by the surgery offers people a great new incentive to eat more carefully, even though they were never able to do so before.

* Eat only three small meals a day
* Eat slowly and chew thoroughly
* Stop eating as soon as you feel full
* Do not drink while you are eating
* Do not eat between meals
* Eat only good quality foods — no junk!
* Avoid fibrous foods
* Drink enough fluids during the day
* Drink only low-calorie liquids
* Exercise at least 30 minutes a day

The gastric bypass patient can expect an uncharming side effect called “dumping syndrome,” which 85% of patients experience at some point. We’re talking about nausea, diarrhea, bloating, sweating, weakness and pain. On the other hand, some see this as a benefit. These symptoms provide very strong and immediate negative reinforcement, to discourage a person from eating sugar and carbohydrates.

The gastric bypass patient could face serious consequences due to malnutrition. WebMD mentions osteoporosis and anemia. With biliopancreatic diversion, there is an even greater chance of consequent deficiency, which is why the operation is relatively rare. Bottled vitamins will now be part of this person’s life forever. The post-op patient will need close monitoring, special foods, special preparation methods, and supplements throughout the remaining span of life. If the person winds up in uncongenial circumstances where these things are not available, such as prison or a homeless encampment, that will just be too bad.

Your responses and feedback are welcome!

Source: “Choosing a Type of Weight Loss Surgery,” WebMD
Source: “Weight Loss Surgery Slideshow,” WebMD.com, 05/25/10
Source: “Illustrated Guide: What to Expect With Weight Loss Surgery,” WebMD, 05/25/10
Source: “LAP BAND Diet Guidelines,” University of California, San Diego Medical Center
Image by didbygraham (Graham Richardson), used under its Creative Commons license.

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OVERWEIGHT: What Kids Say explores the obesity problem from the often-overlooked perspective of children struggling with being overweight.

About Dr. Robert A. Pretlow

Dr. Robert A. Pretlow is a pediatrician and childhood obesity specialist. He has been researching and spreading awareness on the childhood obesity epidemic in the US for more than a decade.
You can contact Dr. Pretlow at:

Presentations

Dr. Pretlow’s invited presentation at the American Society of Animal Science 2020 Conference
What’s Causing Obesity in Companion Animals and What Can We Do About It

Dr. Pretlow’s invited presentation at the World Obesity Federation 2019 Conference:
Food/Eating Addiction and the Displacement Mechanism

Dr. Pretlow’s Multi-Center Clinical Trial Kick-off Speech 2018:
Obesity: Tackling the Root Cause

Dr. Pretlow’s 2017 Workshop on
Treatment of Obesity Using the Addiction Model

Dr. Pretlow’s invited presentation for
TEC and UNC 2016

Dr. Pretlow’s invited presentation at the 2015 Obesity Summit in London, UK.

Dr. Pretlow’s invited keynote at the 2014 European Childhood Obesity Group Congress in Salzburg, Austria.

Dr. Pretlow’s presentation at the 2013 European Congress on Obesity in Liverpool, UK.

Dr. Pretlow’s presentation at the 2011 International Conference on Childhood Obesity in Lisbon, Portugal.

Dr. Pretlow’s presentation at the 2010 Uniting Against Childhood Obesity Conference in Houston, TX.

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