It is the nature of man to always look for the easy way out. Saving time in today’s fast-paced society has become a goal in and of itself. When it comes to our health, this is no exception. If we could turn the clock back about 50 years or so, we all would have been naturally more active, would have consumed less food and would not have been inundated with a food and beverage industry that was trying to convince us to eat what they are selling in large amounts – when were weren’t even hungry. So today, the overweight/obesity epidemic is upon us. Logically, if a person realizes that this causes ill health in the form of diabetes, hypertension, high cholesterol, fatty liver disease and mental illness, he should want modify his lifestyle and make the changes necessary to achieve good health, quality of life and longer life. But we still look for the easy way out, even though it doesn’t really exist. The sudden popularity of bariatric procedures for rapid weight loss is frightening, and potential dangerous. The paradox of someone trying to better their health, while at the same time possibly harming their health, is evident in these procedures.
Let us first examine what these procedures are and how they work.
Most invasive: Gastric Bypass
What it is: In this procedure, a large section of the stomach is stapled off. A small pouch remains that is connected to a section of the small intestine.
Why it works: Patients aren’t so hungry and therefore lose weight quickly. This is in part because the shrunken stomach can hold just a few ounces of food or liquid, and also because the bypass means that hormonal signals of fullness and satiety are sped up, since the undigested food enters the intestine so soon after it is eaten.
Success rate: Just about all (more than 95%) patients lose at least half of their excess weight, making this one of the most effective types of bariatric surgery. However, an estimated 15% regain a significant amount of weight.
Downside: Patients are less able to absorb nutrients from their foods, so those who’ve had this surgery must be vigilant about eating enough protein and will need to take vitamin and mineral supplements. Also, eating sweets or fatty foods can cause cramping, diarrhea, sweating, fatigue and light-headedness.
Best for: Because the overeating impulse gets blocked, this can be a good solution for people who binge on junk food, people who have diabetes and those who have difficulty chewing and eating slowly.
Least Invasive: Gastric Banding
How it works: An adjustable plastic band is surgically inserted and then cinched around the upper part of the stomach, limiting how much you can eat and slowing the passage of food into the stomach. Patients feel full after eating less. Since neither the stomach nor the intestine is cut, this is the least invasive weight-loss surgery.
Success rate: Two-thirds of patients meet their weight-loss goals, losing about half their excess weight on average, and sometimes much more.
Best for: Since this procedure limits how much you can eat at one time, it can be a good solution for people who are big eaters.
Downsides: Since the opening to the stomach is narrowed, it becomes very hard to digest fibrous foods, pasta, rice and red meat (all foods, and especially these, must be thoroughly chewed or patients suffer severe discomfort). Fluids are limited; patients cannot drink any liquids within an hour of eating. Also, in as many as half of patients, the band slips at some point afterward, which requires an additional procedure for adjustment.
Permanent: Sleeve Gastrectomy
How it works: Sixty percent of the stomach is surgically removed and the shape is changed to a tube (or “sleeve”), which results in a permanent restriction on how much food you can eat at one time. Also, the portion of the stomach that produces the hunger hormone ghrelin is removed, so hunger pangs are diminished.
Success rate: Success rate is slightly less than with gastric bypass, mostly because the procedure leaves a larger portion of the stomach intact so patients can still eat more than they should.
Best for: Sleeve gastrectomy doesn’t involve bypass, so patients maintain the ability to absorb vitamins and minerals at near-normal levels, making it a good option for most patients. Dr. Bessler, Director of the Center of Bariatric Surgeries at Columbia-Presbyterian Hospital in New York, predicts this operation will become more popular because it is more reliable for weight loss than the lap band and simpler than bypass.
Downside: It’s permanent and cannot be undone. If patients overeat, it can stretch the stomach , resulting in the need for an additional procedure.
Dr. Bessler explains, “Bariatric surgery is a big deal; all surgeries carry some risk, and these procedures are major, not minor. The likelihood of certain complications – cardiac problems and pneumonia, in particular, increases with patients’ obesity levels. Depending on the procedure, there is some risk for surgical complications (bleeding, leaks and bowel obstructions) as well.”
Bariatric procedures are potentially life-threatening in some rare cases, but other complications can abound. In experienced hands, the overall complication rate of this type of surgery ranges from 7% for laparoscopic procedures to 14.5% for operations through open incisions, during the 30 days following surgery. Mortality for this study was 0% in 401 laparoscopic cases, and 0.6% in 955 open procedures. Similar mortality rates – 30-day mortality of 0.11%, and 90-day mortality of 0.3% – have been recorded in the U.S. Centers of Excellence program, the results from 33,117 operations at 106 centers.
Dr. Guilherme M. Campos, lead author of one of two papers appearing in the February issue of the Archives of Surgery, found in a study he conducted of both banding and bypass patients, that roughly equal numbers of patients in each group experienced complications after one year (12% in the gastric bypass group compared to 15% in the lap-banding group); these included infection, internal bleeding and blood clots, but no deaths. More people in the bypass group had complications right after the surgery. More of those undergoing lap-banding, however, needed repeat surgeries (13% vs. 2%).
Next week’s column will examine the side effects and complications of these procedures, and on the alternative methods we can employ to achieve healthy and sustained weight loss.
Alan Freishtat is an A.C.E. CERTIFIED PERSONAL TRAINER and a LIFESTYLE FITNESS COACH with over 15 years of professional experience. He is the co-director of the Jerusalem-based weight loss and stress reduction center Lose It! along with Linda Holtz M.Sc. and is available for private consultations, assessments and personalized workout programs. Alan also lectures and gives seminars and workshops. He can be reached at 02-651-8502 or 050-555-7175, or by email at [email protected]
Check out the Lose It! website at www.loseit.co.il. US Line: 516-568-5027