None — Surgery for Obesity
A normal weight is a BMI of 18.5 to 24.9. People with a BMI of 25 to 29.9 are considered to be overweight. A BMI of 30 to 30.9 is classified as obesity and 40 and above as extreme obesity. Rates of obesity in the U.S. have doubled since 1980. Researchers estimate more than 32 percent of American men and 35.5 percent of women are currently obese.
Traditionally, doctors recommend diet and exercise to lose weight and maintain the weight loss. However, some people have a hard time sticking to a diet program, losing some weight and then eventually re-gaining it (and sometimes even more). People who are obese may especially have a hard time because they have an extreme amount of weight to lose and are often unable to participate in regular exercise.
Another option for people who are obese is bariatric surgery. This treatment promotes weight loss by reducing how much food can be taken in at a single time and, with some procedures, limiting the amount of calories that can be absorbed into the body. There are several different kinds of weight loss surgery. In gastric bypass the stomach is sectioned off, creating a very small pouch for food storage (ranging from the size of a golf ball to a football). In addition, the small intestine is detached and reconnected to the new stomach. Food bypasses the duodenum, where most calories are absorbed.
In laparoscopic adjustable gastric banding (sometimes referred to as LAP-BAND® surgery), a donut-shaped silicone band is wrapped around the upper stomach. A balloon inside the band is inflated with saline, squeezing the tube around the stomach. This creates a small pouch at the top of the stomach with a narrow outlet for food to pass into the rest of the stomach.
Bilio-pancreatic diversion with duodenal switch is a very complex surgery. Most of the stomach is sectioned off, leaving a sleeve-shaped portion to hold food. The short section of the lower end of the small intestine is attached to this stomach. This procedure greatly limits the ability to absorb calories and can lead to vitamin and mineral deficiencies and other complications.
In vertical sleeve gastrectomy, the stomach is only sectioned into a sleeve-like pouch. This procedure restricts the amount of food that can be eaten at one time, but doesn't limit absorption of calories and nutrients.
The American Society for Metabolic and Bariatric Surgery estimates 220,000 Americans had bariatric surgery in 2009. The surgery is recommended for people with the BMI of 40 or higher or those with a BMI 35 or higher who have obesity-related health problems. In addition to weight loss, bariatric surgery reduces the risk for heart disease by 50 percent and resolves many medical conditions caused by the excess weight.
Eating after Bariatric Surgery
Patients who have bariatric surgery typically lose 30 to 50 percent of their excess weight within 6 months and 77 percent of the excess in 12 months. However, the surgery requires a life-long commitment to significant diet and exercise changes to maintain the weight loss.
With a smaller stomach pouch, weight loss surgery patients are only able to take in a very tiny amount of food before they become full. Thus, they need to carefully follow diet recommendations after the surgery. Immediately after surgery, patients are placed on a liquid diet. Laura Periou, R.D., L.D.N., Registered Dietitian with Ochsner Medical Center in New Orleans, says the diet changes are progressive to allow the body to adapt to the new digestive conditions. After leaving the hospital, patients eat only liquid protein supplements or pureed baby food. Gradually, soft, moist foods are added to the diet. Patients must focus on protein because other foods will fill the stomach but provide little nutritional value.
About three months after surgery, patients can gradually transition to solid foods. It's important for patients to chew food thoroughly because larger chunks of food can become stuck in the small opening leading out of the stomach. Lean protein continues to be the main ingredient in the diet. Periou also recommends non-starchy vegetables, fruits and, eventually, whole grains. Patients need to avoid highly processed foods, white bread, pasta and white rice.
Since patients feel full so quickly, they must eat more often. In addition to the three main meals of the day, Periou says small supplements, like a protein drink, hard boiled egg, or a small piece of meat, are ideal for these mini-meals.
It's sometimes hard for patients to stick to such a restricted diet. Thus, patients receive a significant amount of counseling and dietary advice before and after surgery. Periou says patients for whom weight loss surgery fails often regain weight because they start snacking on junk foods. To keep the diet satisfying, she recommends good planning and judicious use of herbs and seasonings to enhance the flavors of foods. She also recommends shopping with a list and choosing foods from the perimeter of the grocery store for the healthiest choices.
For information on weight loss (bariatric) surgery:
American Society for Metabolic and Bariatric Surgery Weight Control Information Network
For information on obesity:
National Heart, Lung and Blood Institute The Obesity Society
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