Surgery: Treating the Severely Obese

Surgery: Treating the Severely Obese

Lead in: According to the World Health Organization, globally there are now more than 1 billion overweight adults, and at least 300 million of them are obese. During the last 40 years, obesity has reached epidemic proportions. There are more obese people each year, and the severity is increasing. In the United States alone, 300,000 deaths are associated with obesity. Thesis: Many obese people fail diet after diet. For them, bariatric surgery is an option even though risks are involved (Flancbaum, et al. 7; Goodman par 3; "The Weight" par 2).

Overview

Obesity is climbing the charts as being a major killer of our population. This paper informs the reader on how bariatric surgery treats the severely obese. Focus is given on who should have bariatric surgery, how the surgery works, risks of bariatric surgery, and what the patient can expect. Bariatric surgery is reserved for people who have been unable to lose weight on professionally managed weight-loss programs and those with obesity-related conditions such as diabetes, or the risk of them.

When surgery is an option for weight loss

The best candidates for bariatric surgery are patients who have a body mass index (BMI) of 40 or greater, or 35 or greater and associated obesity-related conditions such as diabetes, heart disease, and sleep apnea (see figure 1.1, pg 8 & table 1, pg 6). In terms of pounds, qualifying for surgery estimates to being 100 pounds above ideal body weight. A patient must have also gone through some sort of organized weight loss program in the past, and failed to maintain weight loss (Flancbaum, et al.15).

How surgery promotes weight loss

Gastrointestinal surgery for obesity, also called bariatric surgery, alters the digestive process. The operations promote weight loss by closing off parts of the stomach to make it smaller. These procedures are referred to as restrictive procedures because they cut down on the amount of food the stomach can hold. These types of procedures are less common due to the complications involved (Flancbaum, et al. 27, 52).

The most popular operations combine stomach restriction with a partial bypass of the small intestine. These procedures create a direct connection from the stomach to the lower segment of the small intestine, literally bypassing portions of the digestive tract that absorb calories and nutrients. These are known as malabsorptive operations. Malabsorptive operations produce effective weight loss, and often reverse the health problems (see table 2, pg 6) associated with severe obesity (Flancbaum, et al. 50, 67).

What different surgeries entail

Bariatric surgery evolved out of operations for cancer or peptic ulcers disease in which the large portions of the stomach or small intestines were removed. Surgeons adapted these operations to treat the severely obese because patients undergoing these procedures tended to lose excessive weight after surgery.

In 1954, doctors Kremen and Linner pioneered the first bariatric surgery to treat obesity. This surgery was known as the jejunoileal bypass (JIB), or intestinal bypass and was considered malabsorptive. JIB involved shortening the length of the small intestine available for digestion and absorption of food, and by bypassing a large segment of the small bowel which was taken out (see figure 2, pg 9). This procedure resulted in extreme weight loss but long term observation revealed many complications and by 1980 this procedure came to a hault. Complications included malnutrition, severe vitamin/mineral deficiency, and severe diarrhea (Levy 159).

In the late 1960's and 70's, Dr. Edward Mason began use of a procedure called Roux-en-Y gastric bypass (RYGB), also a malabsorptive procedure. This has since become the surgery of choice (see figure 2, pg 9). Over 75 percent of surgeons prefer using this procedure because risks are minimal and can be treated. This surgery involves separating the stomach into two compartments: a small upper compartment and the lower compartment in which food cannot enter after surgery. Food will pass from the small intestine, bypassing the lower part of the stomach. Complications included vitamin deficiency, diarrhea, and dumping syndrome--food passes quickly from stomach pouch to the intestine (Flancbaum, et al. 55-56).

The most common restrictive procedure used today is the gastroplasty also known as vertical band gastroplasty (GVB). This procedure was also introduced by Dr. Edward Mason in the 1970's, and is the second most common procedure outside of the gastric bypass (see figure 2, pg 9). The operation creates a small pouch, one ounce in size, near the crossing of the stomach and the esophagus, using a vertical placed staple line Food passes through the pouch into the rest of the stomach. GVB works by limiting the food that can be eaten in one sitting. Complications (see table 3, pg7) were commonly vitamin deficiency. And technical problems related to staples pulling out, allowing the stomach to return to normal size (Flancbaum, et al. 53).

Risks of surgery

The most serious risk is a risk of dying in the period right around the time of surgery. Overall, the risk of dying is in the neighborhood of 1 percent within the first month or two for both surgeries. Usually death occurs from one of three causes: heart attack, blood clot, or a leak at the connection between the stomach and the small intestine (McGowan 34).

There are certain nutritional consequences in both operations. Certain vitamins and minerals that are not absorbed have to be supplemented, usually just as a pill. For example, a multi-vitamin, vitamin B-12, calcium supplements and iron supplements have to be taken on a daily basis after surgery (see table 3 & 4, p7). In VBG vitamin deficiency is less than 5 percent, whereas in RYGB the percentage is much higher--10-20 percent. Because the risk is much higher in