InformationPDF

Are You a Candidate?

Make the Best Choice for You About Your Surgical Weight Loss Options.According to the National Institutes of Health, you may be a candidate for surgery if you meet at least one of the two following criteria:Have a Body Mass Index (BMI) of at least 40

or

Have a BMI of at least 35 with one or more serious obesity-related condition and meet both of the following criteria:Have failed more conservative weight loss alternatives, such as supervised diet, exercise, and behavior modification programs

and

Are at least 18 years of age

These are not the only things you need to consider as you discuss bariatric surgery. You also need to think about your determination and practical ability to make some serious changes in the way you live your life, not just the way you eat. Bariatric surgery is a tool to help reconstruct and improve your health. As with any new tool,

you must actively learn how to use the tool to get the best benefits.

Body Mass Index (BMI): A method of figuring out the degree of excess weight, based on weight and height.Bariatric: A term having to do with weight or weight reduction
http://www.montrealobesitysurgery.com/bmi.htm

Health Risks of Morbid Obesity

 

Health  Condition

Women

Men

Type 2 Diabetes

400% higher risk of occurrence

400% higher risk of occurrence

High Blood Pressure

210% higher risk of occurrence

190% higher risk of occurrence

Coronary Heart Disease

300% higher risk of occurrence

300% higher risk of occurrence

Stroke

137% higher risk of occurrence


Esophageal Adenocarcinoma (Cancer)

200% higher risk of occurrence

200% higher risk of occurrence

Kidney Cancer

84% higher risk of occurrence

84% higher risk of occurrence

Breast Cancer

50% higher risk of occurrence


 

Higher Mortality Rates*

Women living with morbid obesity have 50 percent to 100 percent higher mortality rates than women with a healthy weight, including a 62 percent higher cancer mortality rate.

Men living with morbid obesity have 50 percent to 100 percent higher mortality rates than men with a healthy weight, including a 52 percent higher cancer mortality rate.

A Note on Relative Risk

These rates refer to “relative risk,” which compares how likely an event is to occur to aperson versus another person. The rates show  how much more likely a person with morbid obesity is to develop cancer or die from cancer versus a person with a healthy weight.

Mortality: A term having to do with death.

Benefits of Bariatric Surgery

How Bariatric Surgery Can Improve Your Life

Bariatric surgery helps you to make the following changes:

Decrease food intake,Lose excess weight,Take control of your overall health,

Many obesity-related health conditions may be improved or resolved, including:

Type 2 diabetes

High blood pressure/heart disease,Osteoarthritis of weight-bearing joints,Obstructive sleep apnea,Gastroesophageal reflux/heartburn,Infertility/menstrual dysfunction,Stress urinary incontinence,Dyslipidemia (lipid metabolism abnormalities)

Overall quality of life for bariatric surgery patients improves greatly. Patients have experienced improvements in many areas of their lives:

Physical functioning and appearance,Social opportunities,Economic opportunities

For an explanation of the risks of bariatric surgery, see Tab 4, Risks of Surgery.

There are three types of bariatric surgery: restrictive procedures, malabsorptive  procedures, and a combination of these procedures.

Type 2 diabetes: A disorder of glucose and insulin metabolism.

Restrictive procedures: Procedures in which the surgeon creates a small stomach pouch that limits the amount of food patients can eat.

Malabsorptive procedures: Procedures in which the surgeon reroutes the small intestine so that food skips a portion of it, reducing the amount of calories and nutrients that are absorbed

Risks of Abdominal Surgery

Risks Associated with Abdominal Surgery

There are risks associated with abdominal surgery. You can  think of risks in the following way: Some are associated with surgery, some are specific to a particular bariatric procedure, and some may be unique to you.6  Your weight, age, and medical history play a significant role in determining your specific risks. If you have health conditions such as heart disease or diabetes, or if you are on certain medications (such as blood-thinning medications) or have had other surgeries, your surgeon will inform you about your specific risks for bariatric surgery.

Risks associated with any general abdominal surgery include:

Bleeding,Pain,Shoulder pain,Pneumonia,Complications due to anesthesia and medications,Deep vein thrombosis,Injury to the stomach, esophagus, or surrounding organs,Infection,Pulmonary embolism,Stroke or heart attack,Death

Risks Associated with Bariatric Surgery

Risks associated with all bariatric surgeries include:

Abdominal hernia,Chest pain,Collapsed lung,Constipation or Dehydration,Enlarged heart

Gallstones, pain from passing a gallstone, inflammation of the gallbladder, or surgery to rem•Stretching of the stomachove the gallbladder,Gastrointestinal inflammation or swelling,Stoma obstruction,Surgical procedure repeated,Vomiting and nausea.

The following tabs will review the unique risks associated with each type of bariatric procedure.

Abdominal: Referring to the part of the body between the ribs and the pelvis that encloses the viscera.

Deep vein thrombosis: Blood clot.

Pulmonary embolism: A sudden blockage of a lung artery by material circulating in the blood; most often a blood clot from a deep vein in the lung or pelvis.

Understanding Adjustable Gastric Banding: A Restrictive Procedure

How Does It Work?

The surgeon implants two medical devices in the patient: a silicone band and an injection port. The silicone band is placed around the upper part

of the stomach and molds the stomach into two connected chambers. The injection port is attached to the abdominal wall, underneath the skin. The  port is connected to the band with soft, thin tubing.

The band is adjustable. Adjustments are made by your healthcare professional using a needle to inject saline solution into your band through the port.Adding saline increases the amount of restriction provided by the band, helping patients feel full sooner and stay full longer.The normal digestive process and nutrient absorption remain unchanged. The gastric band can be removed; however, reversal surgery is not simple.

Abdominal wall: The muscles and connective tissue that extend from the ribs to the pelvis.

Saline: A safe fluid frequently used in intravenous drips (IVs).

Adjustable Gastric Banding

What Are the Benefits?

Gastric banding limits the amount of food you  can eat at one time. For this reason, you will feel full sooner than usual. The stoma created by the band also slows the flow of food from the small upper stomach to the lower stomach. This means you will feel full sooner and stay full longer, and you will have better control of your appetite.

If you try to eat more than 4 ounces of food at a meal, you may feel uncomfortable and may regurgitate. This reaction is common, but often is due to inappropriate eating behaviors. You quickly will learn how to eat to avoid discomfort and regurgitation. As you eat less food, your body will stop storing excess calories and it will begin to use its fat energy stores. The goal is to lose a healthy 1 to 2 pounds a week.

Important Statistics

Studies show banding patients:

Typically lost 47 percent of their excess weight,Resolved type 2 diabetes in 47.8 percent of patients,Resolved high blood pressure in 38.4 percent of patients,Improved high cholesterol in 78.3 percent of patients

What Are the Risks, Complications, and Side Effects?

Additional risks and complications associated with the gastric band include:

Migration of implant (band erosion, band slippage, and port displacement),Tubing-related complications (port disconnection and tubing kinking),Band leak, Esophageal spasm,Gastroesophageal reflux disease (GERD),Inflammation of the esophagus or stomach,Port-site infection.

Other non-serious complications also were reported in a U.S. clinical study.13  None of these complications are usually life threatening. To learn more about the U.S. clinical study, see Tab 8, Realize  Personalized Banding Solution.

Regurgitate: To cause backward flow of food from the upper stomach

 

Understanding Vertical Sleeve Gastrectomy: A Restrictive Procedure

How Does It Work?

During this procedure, the surgeon creates a small, sleeve-shaped stomach. It is larger than the stomach pouch created during Roux-en-Y Gastric Bypass—and is about the size of a banana.

Vertical Sleeve Gastrectomy typically is considered as a treatment option for bariatric surgery patients with a higher BMI. In this situation, it is performed as the first procedure in a two-part treatment. The second part of the treatment is usually a gastric bypass. The use of sleeve gastrectomy as a primary procedure has had successful short-term results.

What Are the Benefits?

Research shows Vertical Sleeve Gastrectomy is part of an effective strategy for surgical weight loss in patients with a BMI of 60 or greater. Vertical Sleeve Gastrectomy is an alternative for patients suffering from morbid obesity whose health risks are too complicated for traditional surgical weight loss methods.

Vertical Sleeve Gastrectomy

Important Statistics

Vertical Sleeve Gastrectomy patients:

Resolved other serious, obesity-related conditions 12 to 24 months after sleeve gastrectomy in 345 patients Typically lost between 33 percent and 83 percent of their excess weight 12 to 24 months after sleeve gastrectomy 12 to 24 months after surgery had resolution rates of diabetes,hypertension, hyperlipidemia, and sleep apnea comparable to other restrictive procedures.Resolved type 2 diabetes in 47 percent to 100 percent of patients (345 patients in four studies having 12- to 24-month follow-up).Resolved hypertension in 15 percent to 93 percent of patients (345 patients in four studies having 12- to 24-month follow-up).Resolved hyperlipidemia in 45 percent to 73 percent of patients (186 patients in two studies with 12-month follow-up).Resolved obstructive sleep apnea in 56 percent to 100 percent of patients (227 patients in three studies with 12- to 18-month follow-up)

What Are the Risks, Complications, and Side Effects?

Additional risks and complications associated with Vertical Sleeve Gastrectomy include:

Dehiscence (separation of tissue that was stitched or stapled together),Leaks from staple lines,Ulcers,Dyspepsia,Esophageal dysmotility,Fistula.

 

Understanding Roux-en-Y Gastric Bypass: A Restrictive and Malabsorptive Procedure

How Does It Work?

During the procedure, the surgeon creates a small stomach pouch. The surgeon then

attaches a section of the small intestine directly to the pouch. This allows food to bypass a portion of the small intestine, which absorbs calories and nutrients. Having the smaller stomach pouch causes patients to feel full sooner and eat less food; bypassing a portion of the small intestine means the patient’s body

absorbs fewer calories.

What Are the Benefits?

Patients report an early sense of fullness and satisfaction that reduces the desire to eat.

Patients who have gastric bypass generally lose more weight sooner than patients who undergo purely restrictive procedures.

Gastric bypass patients can also experience dumping syndrome. This syndrome is a rapid movement of food through the small intestine that leaves the patient feeling flushed and uncomfortable, but it may also be seen as a benefit, as it provides important warning signs that too much sugar or food is being consumed.

Roux-en-Y Gastric Bypass

Important Statistics

Roux-en-Y Gastric Bypass patients:

Typically lost 61.6 percent of their excess weight,Resolved type 2 diabetes in 83.8 percent of patients and often resolved the disease within days of surgery,Resolved high blood pressure in 75.4 percent of patients,Improved high cholesterol in 95 percent of patients,Improved overall quality of life greatly,Improved physical functioning and appearance,Improved social and economic opportunities,Improved depression 47 percent,Resolved osteoarthritis and joint pain 41 percent,Resolved menstrual dysfunction due to polycystic ovarian syndrome 100 percent,Restored ovulation and fertility 100 percent

What Are the Risks, Complications, and Side Effects?

Additional risks and complications associated with Roux-en-Y Gastric Bypass include:

Dehiscence (separation of tissue that was stitched or stapled together)

Leaks from staple lines

Ulcers

Dumping syndrome, an unpleasant side effect that may include vomiting, nausea, weakness, sweating, faintness, and diarrhea

Required supplementation of diet with a daily multivitamin, calcium, and sometimes vitamin B12 and/or iron

Inability to detect the stomach, duodenum, and parts of the small intestine using X-ray or endoscopy, should problems arise

after surgery such as ulcers, bleeding, or malignancy

Increased gas

Stapled: Surgical staples, similar in look and function to those used to fasten paper, are used for connecting tissue. Staples are usually permanent and made of titanium.

Understanding the Biliopancreatic Diversion with Duodenal Switch (BPD/DS): A Malabsorptive and Restrictive Procedure

How Does It Work?

Biliopancreatic Diversion with Duodenal Switch (BPD/DS) is similar to gastric bypass. Instead of a small stomach pouch, the surgeon creates a sleeve-shaped stomach. The surgeon then

attaches the final section of the small intestine to the stomach sleeve. The small intestine absorbs calories and nutrients. Bypassing all but the

last section of the small intestine causes far fewer calories to be absorbed than with normal anatomy.

What Are the Benefits?

Patients report less restriction on consumed food than with other bariatric procedures. BPD/ DS studies also show that this procedure results in the greatest weight loss because it provides the highest levels of malabsorption, and has the highest rate of resolution of type 2 diabetes and hyperlipidemia.5

Other benefits include:

Improved overall quality of life greatly

Improved appearance and physical functioning

Improved social and economic opportunities

Biliopancreatic Diversion with Duodenal Switch

Important Statistics

BPD/DS patients:Typically lost 70.1 percent of their excess

weight:

Resolved type 2 diabetes in 98.9 percent of patients

Resolved high blood pressure in 75.1 percent of patients

Improved high cholesterol in 99.1 percent of patients

Resolved obstructive sleep apnea in 91.9 percent of patients

What Are the Risks, Complications, and Side Effects?

Dehiscence (separation of tissue that was stitched or stapled together)

Leaks from staple lines,Ulcers.Required supplementation of diet with a daily multivitamin, calcium, and sometimes B12 and/or iron,Inability to detect the duodenum and parts of the small intestine using X-ray or endoscopy, should problems arise after surgery such as ulcers, bleeding, or malignancy.Abdominal bloating and foul-smelling stool or gas.

Choosing the Right Procedure for You

Which Procedure Is Right for You?

The different bariatric surgical methods outlined in this flipchart can help patients lose excess weight, lower their BMI, and transform their  health by resolving or improving serious obesity- related conditions. Bariatric surgery has many benefits that can lead to a healthier, higher quality of life. It also has certain risks. Bariatric surgery should not be considered until patients and their healthcare team have explored all other options. The best approach to bariatric surgery calls for discussion of all patient options to determine the best choice.When deciding if bariatric surgery is right for you, be sure to consider the following:

Bariatric surgery is not cosmetic surgery and should not be thought of in any way as cosmetic surgery.Bariatric surgery does not involve the removal of adipose tissue (fat) by suction or surgical removal.Bariatric surgery will not eliminate the emotional desire to eat.As with any surgical procedure, bariatric surgery may present risks.Commitment to long-term lifestyle changes, including healthy and appropriate eating and exercise, is key to success.Problems after surgery may require more operations to correct them.

 

Factors for Success

How Can I Succeed with Bariatric Surgery?

People who attain significant weight loss and better health with bariatric surgery have certain things in common. We call these “Success Factors.” When you are willing to make these Success Factors part of your life, you put yourself in an excellent position to reach your goals.

These Success Factors are:

Success Factor 1: Education. Patients should learn the risks, requirements, and rewards of each bariatric surgery procedure.

Success Factor 2: Support. Patients should surround themselves with a support network of people who want them to succeed.

Success Factor 3: Participation. Patients should start practicing new eating and exercise behaviors before surgery.

Success Factor 4: Healing. Patients should give their bodies time to heal by following their healthcare team’s recovery plan.

Success Factor 5: Nutrition. Patients should eat and drink in a new way. This means smaller portions and appropriate food choices.

Success Factor 6: Exercise. Patients should exercise to reach their goals.

Success Factor 7: Listen. Patients should listen to their body and pay attention to the signals it sends.

Success Factor 8: Follow-up. Patients should see their healthcare team on a regular basis for follow-up care.

Learn More Online

 

These helpful websites provide more information and resources.

Obesity surgery: a solution to lose weight?

http://www.contact.ulaval.ca/article_blogue/chirurgie-de-lobesite-une-solution-pour-maigrir/

asbs.org

The American Society for Metabolic and Bariatric Surgery (ASMBS) offers patient education and support, including clinical information about bariatric surgery and a search tool to find local surgeons and allied health professionals.

BariatricEdge

This website offers helpful resources and insightful guidance as real patients talk about overcoming challenges, and healthcare professionals share their knowledge and expertise. Receive exciting information about improving health and enhancing quality of life through bariatric surgery.

ObesityAction

The Obesity Action Coalition (OAC) provides education, advocacy, and support resources to elevate and empower those affected by obesity, and raises obesity awareness in family members and the public.

Realize Band RealizeBand.com offers guidance and

information helpful for overcoming challenges to weight loss with the REALIZE Personalized Banding Solution. Through REALIZE

my SUCCESS, a customized program for patients with the REALIZE Band, patients get tips and advice tailored specifically to their own needs.

Healthcare professionals also weigh in, sharing their knowledge and expertise about weight loss with this FDA-approved device.

FDA.gov