Let’s Talk about Gastric Bypass Surgery

ICU roomHere’s the rundown on gastric bypass surgery, according to Cheryl Ann Borne, founder of the website My Bariatric Life. To qualify, a person needs a BMI of over 40, or a BMI of over 35 with a complication such as type 2 diabetes. Of course there is a physical exam and lab work, and the patient’s medical history is consulted because several risk factors could indicate that bariatric surgery would be unsafe. There is a psychiatric screening process, covering such matters as eating disorders and history of sexual abuse, depression, or other psychological barriers to success. This describes the preparation:

After you have been approved for gastric bypass, you will need to make lifestyle changes before your surgery. This may include losing weight, diet and fluid restriction, smoking cessation, counseling to prepare you for your post-surgery life, and perhaps beginning a program of exercise. Some health insurers require a mandatory weight loss during this period in order to qualify for the bariatric surgery.

But wait. Things now begin to sound complicated and contradictory, because we are also told that, “health insurers look for a medical history where diet, exercise, and medicine such as prescription weight loss, have been unsuccessful.” If one of the criteria is a history of unsuccessful weight loss attempts by other means, how can the patient then be expected to lose weight in order to be okayed for the surgery?

Whether the patient has or has not successfully lost weight before, this would be a good place to introduce W8Loss2Go, the smartphone application that helps people to stop eating between meals and gradually reduce amounts at meals.

Why Do People Choose Gastric Bypass?

In this field, long-term success is defined as achieving and maintaining a normal BMI for five and a half years. Within that time frame, the success rate for morbidly obese patients (defined as a BMI between 30-49) is said to be 93%, and the success rate for super-obese persons (defined as a BMI of over 50) is said to be 57%.

Compared to other surgical choices, it sounds pretty good. If the patient did everything correctly and followed the post-op protocol faithfully, she or he could expect to lose 60% of the excess weight she or he had been carrying. The most dramatic weight-shedding takes place during the first year, but with proper diet and exercise, continuing loss is expected in subsequent years.

How Does Gastric Bypass Work?

The method is in the name. Ingested food bypasses most of the internal territory it previously would have traversed. The lower end of the stomach is stapled shut, leaving the egg-sized top end, now called a pouch, as the functional part. From there, food is re-routed past areas where calories are normally absorbed, and dumped into the small intestine. Another source adds:

Today, almost all operations are performed laparoscopically: this means they’re done using cameras and instruments inserted into the belly through tiny ports. Instead of a large incision, the surgery leaves only the port scars, about a centimeter each in length.

What Will Life Be Like After a Gastric Bypass?

Recovery is equated with the ability to eat solid food, which might happen after a month or after as long as three months. To rehearse for this ordeal, a person could try going on a 3-month liquid diet, to see what happens. Who knows? It might turn out to provide enough of a boost that the person would decide to forget about surgery and continue to pursue alternate methods.

It is said that, for the first few months, the patient feels full all the time, whether or not a meal has been eaten recently. One startling detail is that if the patient fasts for eight hours (a normal night’s sleep), “incredible hunger will develop.”

Once the person is able to eat solid foods, it is much more useful to eat “heavy” foods (like meat or raw vegetables), because “soft foods” will cause the small pouch to empty too quickly, causing hunger too soon. This, of course, can lead to snacking and other counterproductive behaviors.

Patients are advised to engage in “water loading” before eating—“drinking water as much as possible and as fast as possible.” This helps to achieve the full feeling, so the person will eat less. But “water loading” is a technique that can work just as well for people with no surgery, except for the fact that many health advisors are against it, because it dilutes the stomach acids whose job is to break down the stomach contents into usable form.

The rules also note that post-op patients who exercise regularly have better success, as do those who participate in support groups. But again, this is true of anyone who aspires to lost weight, whether they have surgery or not.

The main thing to know is that this is not a reversible procedure. Once chosen, it is a choice the person is stuck with forever. There is a discouraging warning. Apparently, even those who carefully follow all the rules can expect 20% to 25% of the lost weight to have returned, after ten years. For someone who undergoes this kind of surgery at, say, age 20, this sounds rather grim. By age 30, they can expect to plump up again, only this time, there is no last-resort surgery to save them, because the most extreme measure has already been taken. Again, there is an opportunity here for W8Loss2Go to help stave off that inevitable moment when the pounds start to pile back on.

Your responses and feedback are welcome!

Source: “Gastric Bypass Surgery Facts,” MyBariatricLife.org, undated
Source: “How Gastric Bypass Surgery Works,” mybariatriclife.org, undated
Source: “Is Bariatric Surgery the Solution to America’s Obesity Problem?,” TheAtlantic.com, 04/04/12
Image by Quinn Dombrowski

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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.
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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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