Diet and Weight Loss Weight Loss Surgery

When Dieting is a Bust: Surgical Options for Weight Loss

In addition, it's important to have the patient seen by a dietitian preoperatively to go over the current dietary choices and how those dietary choices might be affected by the operation.

How does obesity surgery work?
There are two general principles by which surgery for obesity works. One is by decreasing the capacity of the stomach. So the portion of the stomach that food gets into is much smaller, the patient feels full quicker, and so they eat fewer calories. The second general mechanism is malabsorption. Food bypasses a segment of intestine to the point that you don't absorb all of the calories that you're eating. That sometimes results in diarrhea or looser bowel movements because more unabsorbed fats are getting into the colon.

What are the different types of bariatric surgery available?
There are basically three general types of bariatric surgery that are available in America today. The simplest to understand is the adjustable gastric band. In that case, a band is wrapped around the upper part of the stomach, creating two chambers in the stomach: a very small upper chamber and a larger lower chamber. The size of the channel between the two chambers can be adjusted after the surgery in order to slow the passage of food from the upper chamber to the lower chamber.

The Roux-Y gastric bypass involves separating the stomach into two compartments: a very small upper compartment and the lower compartment, which food does not get into after the operation. They're completely blocked off from each other. Food will pass directly from the upper, small compartment into the small intestine, bypassing the lower part of the stomach. This surgery accounts for about 80 percent of bariatric surgery procedures in the United States today.

The third one is the duodenal switch. That involves two basic procedures. One is removing about 80 percent of the stomach volume, and then also bypassing the lower part of the small intestine with a long limb of intestine, but not bypassing the stomach directly. That operation results in a little bit more malabsorption in addition to a reduction in calorie intake.

What are the benefits of bariatric surgery?
The benefits can be quite dramatic. In terms of weight loss, we anticipate that patients lose about 70 percent of their excess body weight in one to two years. Among my patients, who on average weigh 390 pounds before surgery, they lose, on average, 135 pounds in a year.

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