In light of the nation's current obesity crisis, it's no surprise that weight-loss surgery is gaining in popularity. Between 1994 and 2009, the number of weight-loss surgeries performed in the United States increased an average of 20% every year. In 2009, there were 350,000 weight-loss surgeries performed, compared to approximately 16,000 in 1994.

Rose Medical Center in Denver has opened the country's first surgical weight-loss center for teens despite warnings that surgical intervention should be a last resort for teenagers, and recent reports that bariatric surgery can resolve diabetes have led some doctors to extend the procedures to a wider patient base.

Types of weight-loss surgery

Several different types of weight-loss surgery are currently available, with more undergoing clinical trials. Bariatric surgeries use two primary methods for helping patients lose weight by restricting caloric intake. Procedures that are restrictive in nature limit the amount of food the stomach can hold. Adjustable gastric banding, commonly referred to as Lap-Band surgery, uses a flexible silicone ring placed around the upper portion of the stomach to create a small pouch that can hold only a small amount of food. Patients feel full sooner, and eat less.

Malabsorptive procedures reduce the amount of nutrients and calories that patients absorb from their foods. Some procedures, such as gastric bypass, use both malabsorptive and restrictive elements to facilitate rapid weight loss. Gastric bypass reroutes the digestive system so that foods bypass the small intestine, where most nutrients are absorbed.

Qualifications

Weight-loss surgery was originally designed to help morbidly obese individuals lose weight. Morbid obesity is defined as a body mass index (BMI) of 40 or higher, or a BMI of 35 or higher with the presence of one or more weight-related health problems. Insurance sometimes covers weight-loss surgery, but patients must first undergo a psychological evaluation, provide a medical history spanning several years, and prove that they have failed to lose weight through conventional methods.

Results

Depending on the type of surgery, patients may lose 25-75% of their excess weight. Success depends on the individual's commitment to developing healthy diet and exercise habits, and those who do not adhere to a low-calorie post-surgical diet and a regular exercise program may not lose any weight at all. Though weight-loss surgery helps patients eat less, it is only one part of a healthy weight-loss program and should be viewed as a weight-loss tool rather than a "quick fix."

Post-surgical diet

With any form of weight-loss surgery, your relationship with food with be permanently changed. You will be restricted to a low-calories diet and will have to learn new ways of eating depending on how your body reacts to the changes. Certain foods and drinks will be prohibited as your altered digestive system will not be able to tolerate them. Patients may not be able to consume caffeine or carbonated beverages. The effects of alcohol are felt more strongly. Lap-Band patients cannot consume solids and liquids at the same time, including foods that contain both, such as cereal with milk. Patients who undergo malabsorptive procedures are at an especially high risk of malnourishment and anemia, and must take vitamin supplements for the rest of their lives.

Complications

With the increasingly popularity of weight-loss surgery, more people with only a moderate amount of weight to lose are seeking surgical treatment. While weight-loss surgery may seem like an ideal solution to many, surgical intervention should not be taken lightly and is not without risks and complications, sometimes severe.

Lap-Band complications

Because Lap-Band surgery involves inserting a foreign object into the body, there are a number of possible risks and complications related to the band. The band can slip, causing pain, nausea, and vomiting, or it can erode, which causes a hole to be worn in the stomach and requires additional surgery to correct. The band often causes a feeling of obstruction or discomfort. Patients may experience unpleasant "productive burping," where undigested pieces of food are regurgitated, or "sliming," a buildup of digestive fluids and saliva in the mouth and throat. Lap-Band surgery also involves placing a port in the side of the abdomen; this port is used to adjust the band and may be visible or palpable under the skin.

Gastric bypass complications

Because gastric bypass reroutes the digestive system, it is a permanent procedure. The risks of gastric bypass include leaks and infections at the staple site, hemorrhaging, hernias, bowel obstruction, nutrient deficiencies, and ulcers.

Addiction transference

A common occurrence in bariatric surgery patients, addiction transference is the process of exchanging one addiction for another. Weight-loss surgery patients who are accustomed to self-medicating with food often find that they need something to replace the act of eating. Alcoholism, gambling, and compulsive shopping are common among people who have had weight-loss surgery. Continued psychological counseling is recommended after surgery to address the emotional issues that previously led to overeating; however, some weight-loss surgery patients report that their pre- and post-surgical counseling was merely perfunctory and failed to address their emotional needs.

Mortality rate

The patient mortality rate for weight-loss surgery is approximately 0.5%, or 1 in 200 patients. The death of a patient three days after Lap-Band surgery last year in Los Angeles revealed that doctors involved with the clinic in question had previously had their licenses revoked and were on probation for acts of gross negligence. The family of Willie Brooks Jr. has filed a lawsuit against Top Surgeons for medical malpractice and wrongful death.

Be informed

Anyone considering weight-loss surgery should understand that these procedures are not without risk and should not be taken lightly. Many patients report that they were unaware of some of the risks and complications prior to surgery. Before proceeding with any surgery, make sure you are well informed of the risks and of your post-surgical responsibilities. Ask to see your doctor's licenses and credentials. Spend some time on bariatric surgery websites and forums such as Lap Band Talk or Thinner Times to read about other patients' experiences before deciding on surgery.

Resources:

• Michael Hiltzik: A death and the lap-band
• My Big Life: Adjustable Gastric Banding
• My Big Life: Roux-en-Y Gastric Bypass