Obesity – Surgical Treatment for Obesity

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What is obesity?

Maintaining a healthy body weight is one of the best ways to avoid weight-related health problems, such as type 2 diabetes or heart disease. But what exactly is a healthy body weight? A measurement based on your height and weight, called your body mass index or BMI, is considered to be a better measure of health risk than just your weight in pounds.

In fact, the medical terms “overweight” and “obesity” are based on BMI values. A BMI between 25 and 30 is defined as overweight, and a BMI of 30 or more is considered obese. The higher your BMI, the greater your risk of developing a weight-related illness.

What can I do to lose weight?

The first thing you should do is contact your healthcare provider. Your healthcare provider will help you develop a healthy eating and exercise plan that can help you lose weight, improve your fitness, and decrease the chances of developing heart disease, high blood pressure, or type 2 diabetes. However, in severe cases, diet and exercise alone may not be enough to help you lose weight. If you have a BMI of more than 40, or if you have serious weight-related health issues, such as diabetes or heart disease, your healthcare provider may talk to you about whether you might be a candidate for weight-loss surgery.

What is bariatric surgery?

Weight-loss surgery (also called bariatric surgery) can help you lose large amounts of weight if you are obese. Weight‑loss surgery is most successful when used as part of a long-term healthy lifestyle change, including diet and exercise.

After surgery, weight loss is often rapid, and then it begins to slow down over the next two years. Weight loss can be maintained over many years after surgery.

What are the different types of weight-loss surgery?

There are several different types of weight-loss surgery. Surgery will reduce the amount of food you are able to eat, reduce the amount of food your body is able to absorb, or both.

One weight-loss surgery that works by restricting the amount of food you can eat is called laparoscopic adjustable gastric banding (also called the lap band). In this surgery, your healthcare provider will make several small incisions in your abdomen. In one incision, a laparoscope (a small, thin tube with a camera on the tip that is used to see the inside of your body) is inserted into the incision. Your healthcare provider will place a band, like a belt, around your stomach, separating it into two pouches. There is a small passage between the two pouches. The food that you eat slowly passes through the narrow passage on the way to the intestine. A tube is attached to the band, and at the end of the tube is a port, or an access point, that is left just below the skin. This access point allows your healthcare provider to adjust the tightness of the band by injecting saline (salt water) into the tube. Making the band tighter will make the passageway smaller, which makes the upper pouch fill faster, making you feel full faster.

Two other common weight-loss surgeries work by reducing the amount of food your body can absorb.

• Gastric bypass surgery. During this surgery, your healthcare provider will make a small pouch at the top of your stomach. This reduces the amount of food you can eat before you feel full. The connection to your small intestine is then moved from the bottom of the stomach to the new pouch. When you eat, the food that you swallow goes into the new pouch and then into the small intestine, “bypassing” your stomach and the upper part of your small intestine, where absorption usually occurs.
• Biliopancreatic diversion with duodenal switch. During this surgery, your healthcare provider will remove most of your stomach. This type of surgery is rarely used because of possible side effects, which include being unable to absorb all the vitamins and nutrients your body needs. If you do have this type of surgery, your healthcare provider will closely monitor your progress to make sure you are getting all the nutrients your body needs.

Not all surgeries are available or covered in all areas. If you are interested in weight-loss surgery, contact your healthcare provider.  They can explain the different procedures, decide if you are a good candidate for surgery, and decide on a procedure that would be the best option for you.

What will it be like after surgery?

You may experience some pain or discomfort after surgery. This is normal. Your healthcare provider will prescribe pain medicine to keep you comfortable. Your healthcare provider will also put you on an all-liquid diet for the first two weeks following your surgery.

Your healthcare provider will tell you how much liquid you should be drinking throughout the day. After you finish with the all-liquid diet, you will be on a soft-food diet for two weeks. Four weeks after surgery, you will likely be able to resume eating solid foods. You will need to remember that your eating habits will have to be adjusted after surgery. You will need to eat smaller portions of food, take small bites and chew your food completely, and avoid foods that are high in fat and sugar.

Your healthcare provider will also want you to get out of bed and start moving around the day after your surgery. Walking and doing leg exercises will help you avoid developing blood clots in your legs. Try not to stay in bed for long periods of time. You should be able to resume your normal daily activities about a day after surgery. It will take a few weeks before you’ll be able to resume exercise or any type of strenuous activity. Your healthcare provider will tell you when you’ll be able to resume those types of activities.

After your surgery, you’ll have frequent appointments with your healthcare provider. You will see your healthcare provider every four to six weeks during the first several months after surgery. This is the time when you will be losing weight rapidly, so your healthcare provider will want to monitor your progress and make sure that you are doing well. After your weight loss slows, you will see your healthcare provider every six to twelve months. At these appointments, your diet and exercise plans will be discussed and your progress will be recorded. You may also have blood tests done.

What changes should I make after surgery?

Losing weight is only half the battle. Keeping the weight off will require making permanent healthy changes to your lifestyle. Along with a healthy diet that you can stick with and an exercise program that you enjoy, increasing your daily activity and finding support among your friends, family, or a support group will be the keys to a successful weight-loss plan. Your healthcare provider will probably advise a regular vitamin supplement if your surgery causes you to not absorb vitamins from food, as well. Make sure you keep taking these to avoid vitamin deficiencies.

Getting Active

Lifestyle changes do not have to be drastic to be effective. Simple measures applied every day can make a significant difference over time. Some examples include:

• Increasing your current physical activity by adding 10 minutes a day, or increasing the intensity from low to moderate. Limit time spent online, watching TV, and playing video games to less than two hours total per day.
• Taking the stairs instead of the elevator
• Parking at the far end of the parking lot and walking to your destination, rather than parking as close as possible. You can also get off the bus one stop earlier and walk the rest of the way.
• Doing more household chores (such as dusting, vacuuming or weeding)
• Walking or running with the dog and/or the kids
• Taking “active” vacations—go hiking or ride bicycles
• Buying a pedometer, which measures how many steps you take each day. Gradually increase your daily number of steps. (Pedometers can be purchased at sporting goods stores.)

Almost everyone can benefit from cutting back on unhealthy fat. If you currently eat a lot of fat, try just one or two of the following changes, or those suggested in our handout on healthier food choices:

• Rather than frying meat, bake, grill, or broil it. Take the skin off before eating chicken or turkey. Eat fish at least once a week.
• Cut back on extra fat, such as butter or margarine on bread, sour cream on baked potatoes, and salad dressings. Use low-fat or non-fat versions of these condiments.
• Eat plenty of fruits and vegetables with your meals and as snacks.
• When eating away from home, watch out for “hidden” fats (such as those in salad dressings and desserts) and larger portion sizes.
• Read the nutrition labels on foods before you buy them. If you need help reading the labels, ask your healthcare provider or your dietitian.

Drink no- or low-calorie beverages, such as water, unsweetened tea, and diet soda. Sugar-sweetened drinks, such as fruit juice, fruit drinks, regular soft drinks, sports drinks, energy drinks, sweetened or flavored milk, and sweetened iced tea can add lots of sugar and calories to your diet.