BOSTON (AP) -- By the tens of thousands, morbidly obese people who have failed at diets, support groups and exercise programs are turning to surgery to lose weight.

Read the full story

December 2, 2003

By Mary Pickett, M.D.
Harvard Medical School

What Is The Doctor's Reaction?

Obesity is a major health concern and a growing national epidemic. Within the United States, the most recent National Health and Nutrition Examination Survey shows us that two out of three adults are overweight or obese. Adults with severe obesity have substantially reduced life expectancies. Life expectancy estimates were recently published for 20-year-old men who have a body mass index of at least 45. For these people, 13 to 20 years of life appear to be lost due to obesity.

A reduced-calorie diet and an active lifestyle with regular exercise are the most important treatments for obesity. However, people with severe obesity can speed weight loss with medications or with one of several stomach surgeries that restrict the filling of the stomach or reduce the efficiency of digestion. For the right person, obesity surgery can be a successful treatment and can improve health. Surgery can reduce weight, reduce or eliminate the need for diabetes medicines in some people, and can improve cholesterol. It can improve complications that are associated with excessive weight, such as hypertension or sleep apnea.

Surgery is not an easy way out of obesity. Complications and side effects are possible. Also, surgery for obesity does not mean that obese people can eat without paying attention to calories, so you could quite literally say it is no "cake-walk."

Two of the most popular obesity surgeries, gastric "banding" surgery and stomach "stapling" surgery, both narrow the stomach and reduce your ability to eat large portions of solid food. Liquids and all their contained calories still pass freely through the stomach, so in order to accomplish weight loss after these surgeries you need to avoid high-calorie beverages.

A more involved surgery, gastric "bypass" surgery, can result in more reliable weight loss but it also puts you at risk for iron deficiency, vitamin deficiencies, and the effects of these nutrition problems, such as fatigue, nerve pain or numbness. Like any surgery on the bowel, it is also possible for gastric bypass surgery to have a complication such as a bowel leak, requiring a repeat operation.

All surgeries that result in rapid weight loss can trigger you to form gallstones.

I very infrequently recommend obesity surgery to my own patients, because for most people that I see, basic diet and exercise options have not been maximized.

What Changes Can I Make Now?

The National Institutes of Health gathered interested physicians at a "Consensus Conference on Obesity." This group of physicians felt that surgical treatments for obesity were worth consideration for individuals who had a body mass index (BMI) above 40, or above 35 if it had already caused an obesity complication (such as obstructive sleep apnea).

Even if you meet criteria to consider obesity surgery, your first step in the direction of surgery will need to be a careful diet. Keep a food diary and a weight diary. If you are able to demonstrate a significant measurable weight loss (even if it levels off), then you will be seen as a better candidate for an operation by any surgeon.

What Can I Expect Looking To The Future?

Obesity surgery has been improved during the past decade, and the operations have been redesigned so that complications occur less often. Recently, laparoscopic techniques with very small incisions have been introduced for gastric banding, and this is a significant advance because obese people can have difficulty healing larger wounds.

There is a new treatment for obesity being examined in research studies: an implanted stomach pacemaker. Its use in a small number of patients who have volunteered to try the stimulator experimentally has shown promising results, as far as short-term weight loss is concerned. It is hoped that the stomach pacemaker, by causing unnoticeable small electric shocks, might slow stomach emptying, and make an obese person feel full despite small portion sizes. We do not have enough information about this stomach "pacemaker" to know whether it will be useful for short-term or long-term weight loss.

Related Areas:

Gastric Surgery For Severe Obesity
See The Healthy Eating Pyramid
Guide To Nutrition And Weight Management