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Weight-loss surgery (also known as bariatric surgery) has been getting plenty of ink lately. High-profile celebrities who have shrunk before our eyes visibly demonstrated how effective and rapid this kind of weight loss can be. You may even know someone who's had the procedure. When the National Institutes of Health (NIH) established criteria for surgical treatment in 1991, insurance companies began to cover the operations, and the number of procedures being done soared.
An estimated 97,000 people underwent weight-loss surgery in 2003, up from about 63,000 one year earlier. In fact, more surgeons are training in weight-reduction procedures in order to treat the growing numbers of people willing to have the surgery. And the new techniques don't require much of an incision. Although the risks of the operations are considered acceptable, it's worth noting that 10 to 25 out of 1,000 patients can die after surgery. Therefore, lifelong medical follow-up and monitoring is required.
 | Still, the most encouraging aspect of the procedure is its permanence. People who undergo the procedure do keep their weight off, which is more than most diet plans can claim. All this good news has created long waiting lists for the procedure — often a year or more. But surgery of any kind shouldn't be considered lightly, and it's not for everyone. |
Liposuction (the removal of fat under the skin with suction) is a cosmetic surgical procedure and isn't used for weight reduction. Liposuction is used to contour specific areas where fat tends to accumulate. Plastic surgery may be done following the rapid weight loss from gastric surgery to remove excess skin.
What the surgery involves
For a long time, gastric surgery to remove a portion of the stomach has been used for treating ulcers or cancer. One notable side effect of the procedure was that patients often lost weight or failed to gain weight following their surgeries. Doctors speculated that removing parts of a healthy stomach would help overweight patients lose weight, too. The premise is a no-brainer: If a normal stomach holds about six cups of food and it's made to hold say, a few tablespoons, then fewer calories can be eaten at a time. Fewer calories means weight is lost. No, it's not brain surgery; it's gastric surgery, and it's complicated. In essence, the plumbing that makes up the stomach, small intestines, and large intestines is rebuilt and retrofitted. Assuming that your memory of high-school anatomy class is as dusty as your yearbook probably is, the following is a quick review.
Normal digestion
 | Normal digestion starts in the mouth when you chew. That's where carbohydrates begin to break down with the aid of an enzyme in the saliva. (See Figure 1, which is adapted from material from the National Institutes of Health.) After chewing, the food travels down the esophagus into the stomach where stomach acids are mixed in to break the food into smaller particles. After it's broken up in this way, the food can be pushed into the small intestines where enzymes are secreted, which break the food particles into nutrients that can be absorbed. |
Figure 1: Normal digestion.
There are three parts of the small intestine: The duodenum (attached to the stomach where calcium, iron, and some vitamins are absorbed), the jejunum (the midsection), and the ileum (connected to the large intestine). The bulk of nutrient absorption takes place in the last two sections. The large intestine is where unabsorbed food particles, mostly fiber, are stored until elimination.
Digestion after surgery
When parts of the normal digestive tract are removed, reconfigured, and reconnected, the path the food takes is altered, and the amount of nutrients absorbed is decreased. When it comes to calories, that's a good thing. But decreased absorption of key minerals and vitamins causes deficiencies and their resulting complications.
Benefits of weight-loss surgery
The obvious and perceptible payoff of the surgery is rapid, and mostly permanent, weight loss, which continues for one-and-a-half to two years. Most patients lose between 30 and 40 percent of their preoperative weight. Less visible are the health improvements that result from losing weight. These are the same health advantages that weight loss from less extreme means delivers. For example:
- Reduction in blood pressure
- Normalization of blood cholesterol and triglycerides
- Improvement of cardiovascular function
- Normalization of glucose levels and improvement in or disappearance of type 2 diabetes symptoms
- In women, improvement of menstrual irregularities, fertility, and urinary-stress incontinence
Like any weight loss, what you don't see makes this surgery worthwhile. You may not be aware of the changes in your lab data, but you feel the results. (And mirrors and airplane seats won't threaten you anymore.)
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