The classical treatment regimen for overweight or obese people, which combines nutritional counseling with exercise and education, has demonstrated relatively little long term success. In general, surgery is reserved for patients in whom conservative measures, such as monitoring caloric intake or controlling appetite with appetite suppressants, have failed. In most cases, surgery is generally reserved for patients who are seriously overweight. Surgical intervention is typically employed in conditions where obesity manifests as a real and immediate danger to a person’s health. Morbid obesity is a serious medical condition and its complications include hypertension, diabetes, congestive heart failure, coronary artery disease, stroke, multiple orthopedic problems and pulmonary insufficiency with markedly decreased life expectancy. Thus, the medical community has used surgical approaches for treatment of morbid obesity.

There have been many surgical approaches to obesity. Most surgical procedures for treatment of serious overweight may roughly be classified as either being directed toward the prevention of absorption of food (malabsorption), or restriction of stomach to make the patient feel full (gastric restriction). Ileojejunal bypass, the first weight loss surgery undertaken thirty years ago, has now been abandoned because of severe complications such as poor subsequent malnutrition, fatal cirrhosis or renal failure. Biliopancreatic by-pass, gastric by-pass, and gastric partitioning (stapling) are the current weight loss surgeries, but the long term side effects have not yet been determined. The most common malabsorption and gastric restriction surgical technique is the gastric bypass. For example, some overweight patients have received implantation of one or more bulking prostheses to reduce stomach volume. The prosthesis limits the amount of food the stomach can hold and as a result causes the patient to feel full. Another weight loss surgery is restrictive method, which surgically makes the patient’s stomach smaller by removing or closing a section of the stomach. This surgical procedure also causes the patient to feel full.

Another surgical procedure for weight loss is the gastric bypass procedure. Open gastric bypass surgery is a surgical procedure used to decrease the size of patient’s stomach, which includes transecting the patient’s stomach and constructing a pouch from a portion of this stomach as well as connecting the pouch to the intestine so that the digested food from the pouch moves into the small bowel. This type of procedure limits the amount of food that is completely digested or absorbed. Although, gastric bypass surgery helps to lose weight and relieves life-threatening diseases associated with extreme obesity, there are several major complications which may require additional treatment. Such surgical interventions are very invasive, and each form of surgery may involve complications. Restrictive surgery may entail a risk of vomiting, for example, and gastric bypass surgery may result in unpleasant consequences known as dumping syndrome. Other complications include pouch enlargement, marginal ulceration and staple line separation (dehiscence).

Endoscopic surgeries used to assist weight loss are primarily focused on the placement of a balloon or other space-occupying device in the patient’s stomach to fill portions of the stomach to provide the patient with the feeling of fullness, thereby reducing food intake. However, such surgeries have been discontinued because, while they were shown to be better than restricted diets in losing weight, their long term use was associated with severe risks such as gastric ulceration and migration of the balloons into the small intestine resulting in intestinal obstructions.

There are currently two weight loss surgeries that have been reported to successfully produce long-term weight loss. They include the Roux-en-Y gastric bypass and the bilio-pancreatic diversion with duodenal switch (BPD). Both surgical procedures reduce the size of the stomach plus shorten the effective-length of intestine available for nutrition absorption. Reduction of the stomach size leads to the decreased stomach capacity and the ability of the patient to absorb in food. Bypassing the duodenum makes it difficult or unable to digest fats, high sugar and carbohydrate rich foods. The most common currently performed weight loss procedure is Roux-en-Y gastric bypass (RYGB). This procedure is highly complicated and is usually utilized to treat people with morbid obesity. One aim of the surgery is to provide feedback to the patient by producing a dumping syndrome if they do eat these fats, high sugar and carbohydrate rich foods. Dumping occurs when carbohydrates in food directly enter the jejunum without being first conditioned in the patient’s duodenum. The result is that most part of the fluid is discharged into the food from the intestinal lining. The total effect makes the patient feel light-headed and leads to severe diarrhea.

A successful weight loss surgery is commonly defined as one that results in at least 50 percents excess weight loss at two years. Although advantageous in the long run, the acute risk benefit ratio of weight loss surgeries has reserved these invasive procedures for morbidly obese patients according to the NIH consensus conference on obesity surgery (BMI greater than 40 kg/m2). Therefore, weight loss surgeries is not an alternative for the majority of overweight people unless and until they become profoundly overweight and are suffering the serious attendant complications.

Related information

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