Obesity Articles

Article / Updated 03-26-2016

Roux-en-Y (often abbreviated RNY, and pronounced roo-en-why) gastric bypass surgery is known as the gold standard of weight loss surgeries. Approximately 80 percent of all surgeries performed in the United States currently are Roux-en-Y. In the 1980s, the term stomach stapling referred to the weight loss procedure known as vertical banded gastroplasty (VBG). Unfortunately, some people use the term stomach stapling for gastric bypass as well, which is an entirely different procedure. The failure rate with VBG was very high, so when people associate gastric bypass surgery with VBG by calling them both stomach stapling, patients sometimes have the impression that gastric bypass has a high failure rate as well — which is not the case. What is it? A Roux-en-Y gastric bypass makes the stomach smaller and bypasses some of the small intestines. The stomach is made smaller by dividing the stomach with staples into two compartments or by partitioning the stomach with staples. Today, surgeons commonly divide the stomach while partitioning it. In the laparoscopic procedure, the stomach must be divided. The smaller stomach is referred to as the pouch. The size of the pouch is about 1 to 2 ounces (between 15 and 20 cc's), or roughly the size of an egg. (As a contrast, the size of a normal stomach is about the size of a football.) The small intestines are divided at a certain length by using a stapler. Of the two cut ends of small intestine, the intestine that was farther away is brought up to the new stomach pouch, and this new hookup is called a gastrojejunostomy. Some people also refer to this as the proximal anastomosis. The other cut end of small intestine is then plugged back into the intestine to complete the circuit, and this is called the distal anastomosis. The small intestine that is attached to the stomach is known as the Roux limb. The other cut end of small intestine is known as the biliopancreatic limb, because it contains the bile from the liver and the enzymes to digest food from the pancreas. When the biliopancreatic limb joins the Roux limb, the small intestine is known as the common channel, and this is where the majority of the food is digested and calories are absorbed. When you have Roux-en-Y surgery, after you chew food and it mixes with saliva in your mouth, the food goes down the esophagus into the new stomach pouch and then into the small intestine. The bile and other enzymes don't join the food until further down the intestines, so there is less time for food digestion and calorie absorption. Who does it work for? If you need help with portion control, you may be a good candidate for a Roux-en-Y. The small pouch will keep you from overeating. When you eat more than your pouch holds, you'll feel a pain or discomfort in your chest and will likely throw up the food. What are the pros and cons? Here are the advantages the Roux-en-Y gastric bypass surgery offers to patients: Up to 96 percent of patients see a cure or improvement of their diabetes. Up to 90 percent of patients see a cure or improvement of their high blood pressure. Up to 80 percent of patients see a cure or improvement in their sleep apnea. Patients see a lessening of pain related to osteoarthritis. Patients see a lessening of their gastric reflux symptoms. Some patients see an improvement in their fertility. Patients experience great weight loss. Patients can maintain an average of 65 to 70 percent of excess weight loss at five years after surgery. In other words, they can expect to lose 65 to 70 percent of the amount that they're overweight. Patients experience better long-term weight loss than with diet, exercise and medication. On average, patients experience more weight loss than with behavioral modification. Patients are less likely to gain back the weight they've lost than are patients of some of the other weight loss procedures. Patients experience rapid weight loss, and they can achieve most of the weight loss within the first year. The small gastric pouch forces patients to modify their diets. Some patients experience what's known as the dumping syndrome (a major discomfort!) if they eat something too high in sugar or fat. Though it's the most popular form of weight loss surgery performed today, Roux-en-Y does have drawbacks: Because the stomach is divided and the small intestines are rerouted, leakages can occur right after surgery. Because Roux-en-Y is surgery, it can involve complications such as pulmonary embolism (a blood clot to the lungs), bleeding, infection, stricture (a severe narrowing of the hookup of the stomach to the intestine due to scar tissue), hernia, and even death. Ulcers can occur at the hookup of the stomach to the intestine. You may regain some of the weight you've lost if you don't watch your diet and follow an exercise regimen. You may have gas, and it could smell worse than it did before surgery (though your doctor can help with this). For the rest of your life, you're at a slight risk for intestinal obstruction. You have to modify your diet. You may experience more-frequent bowel movements. You may experience nutritional deficiencies and, therefore, you have to take nutritional supplements for the rest of your life. You may experience the sickening sensations of dumping syndrome if you eat something too high in sugar or fat. The surgery to reverse Roux-en-Y gastric bypass is more difficult than Roux-en-Y itself, so the reversal surgery is not readily performed. After your gastric bypass, call your surgeon if you experience any abdominal problems or any other new concerns. He may have seen a similar problem in other patients.

Article / Updated 03-26-2016

Weight loss surgery is just a broad category for several different weight loss procedures. Here are some basic descriptions of the most common weight loss surgeries: Roux-en-Y (pronounced roo-en-why) gastric bypass: A procedure in which the stomach and intestines are divided and rearranged to make a new small stomach (known as a pouch) and bypass part of the stomach and the intestines. Initially after the surgery, you’ll eat very small portions. This procedure is the most common weight loss procedure being done today. Adjustable gastric banding: A procedure in which an inflatable silicone band or ring is placed around the upper part of the stomach. The band has a port that is placed under the skin, which is used to inflate the band. The port is accessed with a needle through the skin, and saline is added or removed; this is known as a fill or adjustment. Adjustments are given to reduce hunger and portion size and increase weight loss. The procedure is usually done laparoscopically. Sleeve gastrectomy: A procedure in which up to 70 percent of your stomach is removed. The pylorus, which regulates the entry of food into the intestine, is not removed, and food enters the intestine normally. Initially after the surgery, you’ll feel less hungry and eat a lot less. This procedure has been increasing in numbers. Biliopancreatic diversion: A procedure in which part of the stomach is removed and a significant intestinal bypass is performed. The biliopancreatic diversion can be performed in two ways, and the difference between the two procedures lies in which part of the stomach is removed. In the first version, known simply as biliopancreatic diversion, the lower part of the stomach is removed, and the remaining stomach is hooked up to the part of the small intestine that is closer to the colon, known as the ileum. In the second version, biliopancreatic diversion with duodenal switch, the outer curve of the stomach is removed, and the first part of the small intestine is hooked up to the ileum. Approximately 90 percent of the small intestine is bypassed in both the surgeries, resulting in significantly fewer calories and nutrients being absorbed. Weight loss is maximized, but nutritional deficiencies can occur more frequently than with the other weight loss procedures, so you need to take nutritional supplements for the rest of your life.

Article / Updated 03-26-2016

So, you want to explore the option of weight loss surgery. You’ve tried diets in the past and regained all the weight you lost. This type of yo-yo dieting is common — you’re not alone. Here are some ways to get more information about the different types of procedures that are out there: Tell your primary-care doctor or gynecologist that you’re thinking about weight loss surgery. Your doctor may have other patients who’ve undergone weight loss procedures and be able to share with you the results. Your doctor also may be able to refer you to a respected weight loss surgeon in your community. Read as much as possible about the different procedures. Exercise caution when it comes to what you read online — some sites are more accurate than others. You may want to start with the website of the American Society for Metabolic & Bariatric Surgery (www.asmbs.org), where you can get info about risks and benefits of weight loss surgery. Attend an information session at a local hospital or at a weight loss surgeon’s practice. Here you can hear firsthand how the surgeries are done and get your questions answered. If you know someone who has had weight loss surgery and if he or she is open to talking about it, ask about the experience. Find out what kind of procedure the person had and what the pros and cons have been.

Article / Updated 03-26-2016

Weight loss surgery is not for everyone, but it does offer many benefits. Losing a significant amount of weight — and keeping it off — can impact numerous medical and physical aspects of your life. Here’s a quick rundown on some of the things that improve after weight loss surgery: All patients see a significant decrease in joint pain. Every pound you lose is like taking 3 pounds off your knees! Up to 90 percent of patients see a remission of or improvement in their type 2 diabetes. Up to 80 percent of patients see a remission of or improvement in their high blood pressure. Up to 70 percent of patients see a remission of or improvement in their sleep apnea. Some patients see a lessening of their gastroesophageal reflux disease (GERD) symptoms. Some patients see an improvement in their fertility. On average, patients experience greater weight loss than with diet, exercise, and medication.

Article / Updated 03-26-2016

So, you’ve decided to go ahead with weight loss surgery. One of your first steps should be to check your insurance policy to make sure you’re covered for the procedure you want to undergo. You can do this online or by calling your insurance company’s customer service number. Here are a few additional steps you can take to help improve your chances of getting your insurance company to cover the procedure: Write down all the different diets you’ve been on, how much weight you lost, and how much you regained. Document whether you’ve ever taken any weight loss medication. Get office notes from any doctors or dietitians you’ve seen to help you lose weight. If you know your insurance company wants a six-month doctor-supervised diet, get started! Ask your doctor to see you every month and document your weight, what kind of diet you’re on, and what kind of behavior modification or exercises you’re undertaking. If you can’t exercise because of physical limitations, have your doctor document your physical disabilities.

Article / Updated 03-26-2016

You’ve decided to have weight loss surgery — or at the very least, look into it further. Finding a surgeon is one of the most important steps in this process. Here are some ways to find a reputable weight loss surgeon: Go to the website of the American Society for Metabolic & Bariatric Surgery (www.asmbs.org) or the American College of Surgeons (www.facs.org). Both of these websites have a “Find a Surgeon” tool that you can use to find surgeons in your area who are board certified and have experience in weight loss surgery. Ask your primary-care doctor or gynecologist for a referral to a weight loss surgeon. They’ll likely have patients who have undergone weight loss surgery, seen their success, and can help guide your choice of surgeon. Go to ObesityHelp (www.obesityhelp.com) and the websites of the weight loss surgeons you’re considering. Read patient testimonials about surgeons to find the one that’s best for you. Ask family, friends, and acquaintances for referrals. If you know people in your area who’ve had weight loss surgery, ask about their experiences with their surgeons, the hospitals where they had their surgeries, and their surgeons’ staffs.