Options for Treatment
Most non-surgical weight loss programs are based on some combination of diet and regular exercise. Unfortunately, even the most effective interventions have proven to be effective for only a small percentage of patients. It is estimated that less than five percent of individuals who participate in non-surgical weight loss programs will lose a significant amount of weight and maintain that loss for a long period of time.

According to the National Institutes of Health, more than 90% of people in these programs regain their weight within one year. Sustained weight loss for patients who are morbidly obese is even harder to achieve. Serious health risks have been identified for people who move from diet to diet, subjecting their bodies to a severe and continuing cycle of weight loss and gain known as "yo-yo dieting."
The fact remains that morbid obesity is a complex, multi-factorial, chronic disease.

For many patients, the risk of death from not having the surgery is greater than the risks from the possible complications of having the procedure. That is the key reason why American Society for Metabolic & Bariatric Surgery estimates that over 100,000 surgical weight loss procedures are performed annually. Patients who have had the procedure and who are benefiting from its results report improvements in their quality of life, social interactions, psychological well-being, employment opportunities and economic condition.

In clinical studies, candidates for the procedure who had multiple obesity-related health conditions questioned whether they could safely have the surgery. These studies show that selection of surgical candidates is based on very strict criteria and surgery is an option for the majority of patients.

Weight loss surgery is major surgery. Its growing use to treat morbid obesity is the result of three factors:

• Our current knowledge of the significant health risks of morbid obesity
• The relatively low risk and complications of the procedures vs. not having the surgery
• The ineffectiveness of current non-surgical approaches to produce sustained weight loss

Surgery should be viewed first and foremost as a method for alleviating debilitating, chronic disease. In most cases, the minimum qualification for consideration as a candidate for the procedure is 100 lbs. above ideal body weight or those with a Body Mass Index of 40 or greater. Occasionally a procedure will be considered for someone with a BMI of 35 or higher if the patient's physician determines that obesity-related health conditions have resulted in a medical need for weight reduction and, in the doctor's opinion, surgery appears to be the only way to accomplish the targeted weight loss. In many cases, patients are required to show proof that their attempts at dietary weight loss have been ineffective before surgery will be approved. More important, however, is the commitment on the part of the patient to required, long-term follow-up care. Our surgeons require patients to demonstrate serious motivation and a clear understanding of the extensive dietary, exercise and medical guidelines that must be followed for the remainder of their lives after having weight loss surgery.

How Surgery Reduces Weight
Surgeons first began to recognize the potential for surgical weight loss while performing operations that required the removal of large segments of a patient's stomach and intestine. After the surgery, doctors noticed that in many cases patients were unable to maintain their pre-surgical weight. With further study, surgeons were able to recommend similar modifications that could be safely used to produce weight loss in morbidly obese patients. Over the last decade these procedures have been continually refined in order to improve results and minimize risks. Today's bariatric surgeons have access to a substantial body of clinical data to help them determine which surgeries should be used and why. Today, the American Society for Metabolic & Bariatric Surgery describes two basic approaches that weight loss surgery takes to achieve change:

• Restrictive procedures that decrease food intake
• Malabsorptive procedures that alter digestion causing food to be poorly digested and incompletely absorbed so that it is eliminated in the stool

Restrictive Procedures
The theory is simple. When you feel full, you are more likely to have reduced feelings of hunger and will no longer feel deprived. The result is that you are likely to eat less. Restrictive weight loss surgery works by reducing the amount of food consumed at one time. It does not, however, interfere with the normal absorption (digestion) of food. In a cooperative and compliant patient, the reduced stomach capacity, along with behavioral changes, can result in consistently lower caloric intake and consistent weight loss.

During recovery, patients must adhere to the strict specific dietary guidelines and restrictions their surgeon prescribes. When the time comes to resume eating "regular" food, the patient must learn to adapt to a new way of eating. At each meal, they are restricted to consuming approximately 1/2 to a full cup of food before feeling uncomfortably full. Patients who see the best results from a restrictive procedure are those who learn to eat slowly, eat less, and avoid drinking too many fluids, particularly carbonated beverages. The effectiveness of a restrictive procedure is reduced by constant snacking or by drinking high-calorie, high-fat liquids. Failure to achieve the expected level of weight loss is usually the result of a patient failing to comply with the recommended dietary and behavior modifications, such as increased exercise and regular support group attendance.

Malabsorptive Procedures that Alter Digestion
It can be said that some of the restrictive approaches discussed above have not always achieved the excess weight loss surgeons and patients anticipated. For this reason, procedures that alter digestion, known as malabsorptive procedures, were developed to work in conjunction with restrictive approaches. Some of these techniques involve a bypass of the small intestine, thus limiting the absorption of calories. On balance, malabsorptive or malabsorptive/restrictive procedures have resulted in an overall increase in the loss of excess weight. The risk of complications and side effects generally increases with the lengthening of the small intestine bypass. You and your surgeon must determine the risks and benefits over your lifetime with the type of weight loss surgery you choose.

Basically, weight loss operations fall into three categories:

• Restrictive procedures make the stomach smaller to limit the amount of food intake
• Malabsorptive techniques reduce the amount of intestine that comes in contact with food so that the body absorbs fewer calories
• Combination operations take advantage of both restriction and malabsorption

The Gastrointestinal Tract
To better understand how weight loss surgery works, it is important to understand how your gastrointestinal tract functions. As the food you consume moves through the tract, various digestive juices and enzymes are introduced at specific stages that allow absorption of nutrients. Food material that is not absorbed is then prepared for elimination. A simplified description of the gastrointestinal tract appears below. Your doctor can provide a more detailed description to help you better understand how weight loss surgery works.

1. The esophagus is a long muscular tube, which moves food from the mouth to the stomach.
2. The abdomen contains all of the digestive organs.
3. The stomach, situated at the top of the abdomen, normally holds just over three pints of food from a single meal. Here the food is mixed with an acid that is produced to assist in digestion. In the stomach, acid and other digestive juices are added to the ingested food to facilitate breakdown of complex proteins, fats and carbohydrates into small, more absorbable units.
4. A valve at the entrance to the stomach from the esophagus allows the food to enter while keeping the acid-laden food from "refluxing" back into the esophagus, causing damage and pain.
5. The pylorus is a small round muscle located at the outlet of the stomach and the entrance to the duodenum (the first section of the intestine.) It closes the stomach outlet while food is being digested into a smaller, more easily absorbed form. When food is properly digested, the pylorus opens and allows the contents of the stomach into the duodenum.
6. The small intestine is about 15 to 20 feet long and is where the majority of the absorption of the nutrients from food takes place. The small intestine is made up of three sections; the duodenum, the jejunum and the ileum.
7. The duodenum is the first section of the small intestine and is where the food is mixed with bile produced by the liver and with other juices from the pancreas. This is where much of the iron and calcium is absorbed.
8. The jejunum is the middle part of the small intestine extending from the duodenum to the ileum and is responsible for digestion.
9. The least segment of the intestine, the ileum, is where the absorption of fat-soluble vitamins A, D, E and K and other nutrients are absorbed.
10. Another valve separates the small and large intestines to keep bacteria-laden colon contents from coming back into the small intestine.
11. In the large intestines, excess fluids are absorbed and a firm stool is formed.

Which Procedure is Right for You?
The most important step in weight loss surgery is getting all of the information you need about the various surgical options. Ultimately your surgeon and other physicians are your best resource for information about the procedure they will recommend to you. When you ask a question, make sure you understand the answer. Do not hesitate to ask for a clear explanation given in simple language. The decision to have a weight loss surgical procedure may take several visits to their office and consultation with more than one doctor.

You may choose to research weight loss surgery on your own via the Internet or through your local library. As with any search for medical information, be sure that your sources are responsible recognized experts in the field you are investigating. An excellent resource for weight loss surgery is the American Society for Bariatric Surgery.  Although the results of weight loss surgery can be drastic, there are potential risks and complications. Before making your decision, you should be well informed. These steps are necessary if you are to give what is called "informed consent" for the procedure. Informed consent is a legal term meaning that a patient agrees that they have received and understood enough information about a procedure's benefits and risks to allow them to make a decision that is right for them. Your surgeon will require you to sign a consent form before performing your procedure. Before you sign a consent form, you should have a solid understanding of what is about to take place. You should know what you would need to do to live well after the operation. And you should be aware of the signs or symptoms of complications to look for which may occur after your surgery.

Learn about these treatment options:

• Laparascopic or Minimally Invasive Surgery
• Adjustable Gastric Banding
• Roux-en-Y Gastric Bypass
• Sleeve Gastrectomy
• Biliopancreatic Diversion
• Revisional Procedures

Important Considerations
Surgery should not be considered until you and your doctor have evaluated all other options. The proper approach to weight-loss surgery requires discussion and careful consideration of the following with your doctor:

• These procedures should in no way be considered cosmetic surgery
• The surgery does not involve the removal of adipose tissue (fat) by suction or incision
• A decision to elect surgical treatment requires an assessment of the risk and benefit to the patient and the meticulous performance of the appropriate surgical procedure
• The success of weight loss surgery is dependent upon long-term lifestyle changes in diet and exercise
• Problems may arise after surgery that may require re-operations

Success of surgical treatment must begin with realistic goals and progress through the best possible use of well-designed and tested operations.

Learn more about what to expect after surgery >