EXTREME WEIGHT LOSS
America, in general, is a company that thrives on living life in the fast lane. Why sit down to a complete and well-balanced meal, when you can pop through a drive through and get an entire meal for under $5? This type of behavior and decisions add up to a big problem packing on some extra pounds.
Now another obsession that seems to be ever-growing is that of the lust for "thin-ness" and the "perfect body." Now at first glance, these two things don't seem to really be related fast, fatty food and a svelte physique? This is where extreme weight loss comes into play. As the media has recently made us aware, several celebs have gone under the knife, not for a nose job or breast implants, but for a skinnier version of themselves a small portion of their original selves.
But what exactly is weight loss surgery, also called bariatric surgery? Who can benefit from it?
Dr. John Hernried, medical director of the Obesity Treatment Center in California says that nearly all patients in the morbidly obese category, and many in the obese category, qualify for weight loss surgery.
"First of all, surgery must be considered as a tool and not the cure for weight loss," stresses Dr. John Hernried, medical director of the Obesity Treatment Center in Sacramento, CA
"The standard guidelines dictate that those with a BMI over 40, or BMI over 35 with a condition such as diabetes, could be candidates for bariatric surgery" explains Dr. Henried. However, he wants to make it clear that there are exceptions to this rule and patients need to be evaluated individually by their doctor for their specific case.
Mary Gregg, R.D., Director of Health Care at NutriSystem, feels that bariatric surgery should be used after other attempts have failed. "I would not say that I am opposed to weight loss surgery, but I feel that it should be the "last resort" for those individuals who have been unsuccessful at dieting (after several attempts using different approaches)," comments Gregg.
Jeff Novick, Director of Nutrition for the Pritikin Longevity Center & Spa, agrees. "Weight loss surgeries should be a last resort after all other options have been tried," comments Novick. "In my nearly 10 years at the Pritikin Longevity Center, I've seen hundred of men and women lose 50 to 100 pounds and more just by exercising and following diet and exercise plans."
What some people don't realize is that weight can return after surgery and it requires lifestyle change. "It is important to try to have lost weight through diet and most surgeons want proof you have tried to lose by following a diet," clarifies Dr. Henried. "Some people can lose a lot of weight with small dietary changes and it is always worth trying. Others need more intensive weight loss management. At Obesity Treatment Center (OTC) we combine a medically supervised diet with long-term behavioral support that allows for safe and rapid weight loss while acquiring the skills necessary to keep the weight off."
"In my ideal world, I believe it would be important for all patients to come through OTC prior to bariatric surgery," advises Dr. Henried. "Even if they did end up going to surgery, they would be much healthier prior to surgery and would have skills necessary to help them after surgery."
"Bariatric procedures are major surgeries with major complications and the results affect one's lifestyle for years. Numerous individuals contact us at the Health Care Desk at NutriSystem because they have been unsuccessful at reaching their weight loss goals after having bariatric procedures. In conversation, they reveal the limited amounts of food that they are able to consume at one time, eating almost continuously, not being able to eat meat or bread or tolerate sugar. They commonly report the very uncomfortable side effects like nausea, sweating and diarrhea that can occur after bypass operations when rapidly digested foods are consumed. Nutritional deficiencies are a concern, with numerous supplements being required."
There are two main types of procedures: Restrictive Procedures and Combined Restrictive/Malabsorptive Procedures.
Restrictive procedures reduce the amount of food that enters and passes through the digestive tract in the usual order. They include: Adjustable Gastric Banding or AGB, Vertical Banded Gastroplasty or VBG, and Sleeve Gastrectomy.
Combined Restrictive/Malabsorptive procedures combine restrictive and malabsorptive approaches. By adding malabsorption, food is delayed in mixing with bile and pancreatic juices that aid in the absorption of nutrients. The result is an early sense of fullness, combined with a sense of satisfaction that reduces the desire to eat. Combined Restrictive/Malabsorptive procedures include Gastric Bypass Roux-en-Y (RYGBP), Long limb gastric bypass, Biliopancreatic Bypass/Diversion (BPD).
"I would say the two major procedures these days are the Roux-en-y Gastric Bypass and the Adjustable Gastric Banding" says Dr. Henried. "It does appear that the Laparoscopic Band is rapidly increasing in popularity in the US."
Adjustable Gastric Banding (AGB) involves the placement of an adjustable hollow band around the stomach near its upper end, creating a small pouch and a narrow passage into the stomach inducing weight loss through the restriction of food intake. Currently, the "Lap-Band" is the only FDA approved device. The "Lap-Band" is a reversible procedure and may reduce certain risks related to nutritional and mineral deficiencies.
Laparoscopic Adjustable Gastric Banding (LAGB) or "Lap-Band"
Advantages Disadvantages/Complications
Absence of anemia
Decreased risk of dumping syndrome
Greater absorption of nutrients from food
Shorter hospital stays
Lower risk of mortality
Procedure is reversible by band removal
Band Adjustability
Laparoscopic placement Possibility of intra-operative, post-operative and late complications:
Intraoperative complications including hemorrhage, need for conversion to open procedure, and spleen, stomach or esophagus injury
Postoperative complications including band slippage (stomach prolapse), balloon or tubing leak, port infections, band infections, obstruction and nausea/vomiting.
Late complications including band erosion into the, stomach, esophageal dilatation, and failure to lose weight
Gastric Bypass Roux-en-Y (RYGBP) is the most commonly used bariatric surgery in the United States and is the benchmark standard by which all other bariatric surgical procedures are measured. For the proximal gastric bypass, restriction is the primary mechanism and malabsorption may occur. The restrictive element of the procedure involves partitioning the stomach to create a small gastric pouch. The malabsorptive element is created by attaching a Y-shaped section of the small intestine to the new pouch. This element of the procedure allows food to bypass the lower stomach, the duodenum (the first segment of the small intestine), and the first portion of the jejunum (the second segment of the small intestine). The standard jejunal limb is about 75 cm, but may be as long as 150 cm for possible malabsorptive variations.
Open Gastric Bypass Roux-en-Y (RYGBP)
Advantages Disadvantages/Complications
Better weight loss than purely restrictive procedures
Lower incidence of malnutrition
Rapid improvement or resolution of weight related co-morbidities
Reduced appetite Increased risk of early and late complications:
Early complications including anastomotic leak, pulmonary embolism, wound infection, gastrointestinal hemorrhage, respiratory insufficiency, and mortality
Late complications including incisional hernia, bowel obstruction, internal hernia, stomal stenosis, micronutrient deficiencies, and marginal ulcers
Surgery does have confirmed benefits. According to Novick, in an analysis of 136 studies, researchers at the University of Minnesota found that patients who underwent various surgical procedures for obesity lost an average 61% of their excess weight." (JAMA, 2004; 292: 1724)
"Of course, the risks associated with bariatric surgery have to be weighed against the health risks of staying obese," clarifies Gregg. "But if one can achieve the same health benefits of weight loss without the surgery and its associated risks, in a satisfying, convenient and cost-effective way, would that not be a more desirable alternative?"
Novick also believes there are many cons. "According to the Agency for Healthcare Research and Quality, an arm of the federal government's public health service, nearly half of all patients experience complications. The report stated that in 2001 to 2002, about four in 10 bariatric surgery patients experienced significant complications in the 180 days after their operation. About 7% of the 2,522 patients studied even had to be readmitted to the hospital."
"Life after surgery is no easy ride," advises Novick. "To begin with, malnutrition is inevitable unless you take daily supplements of vitamins and minerals because the operation diminishes the digestive tract's absorption of nutrients. Some patients also experience severe hair loss."
Many patients also suffer "dumping syndrome" a complication that arises when food travels too quickly through the small intestine, causing nausea, uncomfortable fullness, cramping, diarrhea, fast heart rate, sweating, and overall weakness.
"But besides the possible side effects, the surgery itself is risky" says Novick. "The University of Minnesota review found that one in 200 died in the month after the operation. Another review of 3,328 patients, published in 2004 in the Journal of the American College of Surgeons (199: 534) found that one in 50 died within 30 days."
Post surgery, physicians routinely advise that patients make a complete change in lifestyle. First of all, your diet gets a complete overhaul. Most meals have to be eaten in much smaller quantities, while some food has to be completely avoided.
Patients are warned not to eat sugary foods, red meat, high-fat foods, high-fiber foods, and milk because they commonly provoke "dumping" symptoms. Too much fat can also cause reflux, a back-up of stomach acid and food into the esophagus that causes heartburn.
Because the "new" stomach can only hold about one-half cup of food at a time, patients are advised to sit down to three to six very small meals every day, eat very slowly, and chew thoroughly. Overeating may cause vomiting, expansion of the stomach pouch, weight gain, or even rupture of the stomach.
A popular non-surgical option for big-time weight loss is NutriSystem. According to Gregg, many NutriSystem customers have achieved weight losses in the range of 100-200 lbs. The NutriSystem program incorporates a healthy well-balanced meal plan which includes all of the foods groups. It is not a "fad" diet and does not restrict any particular foods. It is flexible enough to include dining out; they even offer a Dining Out Guide with the program
According to Novick, the most comprehensive study of long-term weight loss ever conducted, the National Weight Control Registry, found that the vast majority of its nearly 4,500 successful dieters follow a diet that is low in fat and very high in fiber-rich carbohydrates like fruits and vegetables. The members lost, on average, 66 pounds and have kept it off for six years.
"You can undergo gastric bypass surgery, and then make major lifestyle changes," explains Novick, "or you can avoid surgery altogether - and all its risks and downsides - and make the same lifestyle changes that surgery would have forced you to make."
Overall, bariatric surgery its benefits and disadvantages needs to be thought over very carefully. You need to weigh you options, asses how much weight you want/need to lose, and discuss it with you doctor on an individual basis. For some people, it may be the best option, while for others a healthier overall lifestyle is the best route.