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Harvard Commentaries
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Harvard Commentaries
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Food for Thought Food for Thought
 

Gastric Surgery -- The Cure For Obesity?


October 23, 2014


By Natalie Egan, M.S., R.D., L.D.N.
Brigham and Women's Hospital

With two-thirds of Americans overweight or obese, and the numbers continuing to grow, more people are turning to surgical solutions for more permanent weight loss. But is the cut the cure?

There are a variety of surgical options available, and the patient and his or her surgeon should evaluate and determine which procedure meets individual needs. They all have a similar outcome. Restricting stomach size will limit the amount of food eaten and lead to weight loss.

Types of Gastric Surgeries

  • Adjustable gastric banding — An adjustable band is placed around the upper end of the stomach to create a small pouch and narrow passage to the remainder of the stomach. The size of the pouch can be changed over time by inflating or deflating the band.

 

  • Vertical banded gastroplasty — A small pouch is created in the upper part of the stomach with staples and a band, restricting food intake.

 

  • Roux-en-Y gastric bypass — A small pouch is created to restrict food intake, and a Y shaped section of the intestine is attached to the pouch to allow food to bypass part of the intestine. The bypass reduces the amounts of calories and nutrients the body is able to absorb.

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The Skinny on Getting Skinny

Most people that have gastric surgery have a body mass index (BMI) of greater than 40. This is about 100 pounds over ideal weight. If a person has one or more conditions that further complicate his or her health, such as diabetes, sleep apnea, debilitating joint disease or hypertension, a BMI of 35 or greater may be an indication for surgery. Most surgeons will consider persons between the age of 18 years and 60 years of age, though many will assess on a case-by-case basis.

To put the surgery into clearer perspective, it is important that someone considering it understand the risks versus the benefits. Those with morbid obesity often have other diseases — diabetes, high blood pressure, sleep apnea, and heart disease, for example — caused by the obesity. With continued excessive weight such diseases can increase in severity and require major medical attention. Thus, the surgery might allow someone to prevent future and potentially life-threatening complications.

At the same time, the risks of having surgery also should be considered. Complications during or following surgery can include respiratory problems, gastrointestinal problems, gallstones, and nutritional deficiencies that can result in anemia and osteoporosis.

Finally, gastric bypass surgery is a tool, not a panacea. Though your stomach becomes the size of an egg, your brain doesn't change at all. There are many lifestyle and behavioral changes that need to be made in addition to eating habits for long-term success.

It is possible to "eat through" the surgical procedure, meaning that very small amounts of calorie-dense, low-nutrient food or fluid taken constantly throughout the day can add up and slow down weight loss, or even cause weight re-gain. Many who were formerly stress-eaters or emotional eaters no longer have food to comfort them, and often feel "a loss of a best friend." Thwarting this situation early on with support groups, online chat groups and/or counseling helps significantly. The psychological aspects of gastric bypass are just as important as the procedure itself.

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In the Long Run

Weight loss is quick following surgery, but many continue to lose weight for 18 to 24 months afterwards. Many patients regain some of the weight lost, typically between 10% and 20%. Reported long-term success of weight loss is that most keep off 48% to 74% of their initial weight loss at five years.

It is important to remember that there are no guarantees in any method of weight loss, not even the surgical methods. The cut may be the cure for some. The road following surgery is long, and it is not a one-way street. The success of gastric bypass surgery is linked to the commitment to change lifestyle and eating behavior, as well as close medical follow-up.

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Natalie Egan, M.S., R.D., L.D.N., is a senior nutritionist at Brigham and Women's Hospital. She received her Bachelor of Science at Simmons College and her Master of Science in nutrition at Massachusetts General Hospital Institute of Health Professions. She completed her dietetic internship at Vanderbilt University Medical Center. She is an adjunct faculty member at Emmanuel College and Simmons College.

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