Bariatric Surgery: Types of Obesity Surgery, Explained

A fantastic, and open-access, review paper just came out on the subject of surgical solutions to obesity which answered a lot of my questions regarding this growing area of treatment. Written by Kral and Naslund, who are both professors of surgery, it begins with the terse opener "Obesity is very prevalent." Well, in America at least, you can say that again. Obesity is often the result of many different factors, but eventually it becomes clear that our bodies did not evolve in an environment of constant, abundant, and caloric-rich food. Human bodies are designed to want to eat, to love to eat rich and fatty foods, and to store this energy as fat, sometimes in excess.

When these trends become unmanageable, surgical intervention is often considered as an option. What exactly does this involve, and is it safe and effective over the long term? The next few posts will cover this topic, this first one will describe types of bariatric surgery.

(Continued below the fold....)

Techniques In Bariatric Surgery

i-26b95ff83d4954c17df8f9b094d0b413-bariatric.bmp Popup for higher resolution: View image

"Adjustable gastric banding" (A) consists of a stretchy silicone band which can be inflated to constrict the upper stomach into a pouch with a volume of about 30 mL. This pouch remains connected to the rest of the stomach but the connection is narrow, giving the person the feeling of being full when the pouch fills up. The person eats less, and loses weight as a result.

"Gastric bypass" (B) surgically divides the stomach into a permanent pouch (also about 30 mL) seperate from the rest of the stomach which is now renedered non-functional. The new pouch is directly connected to the jejunum of the small intestine, creating a Y formation called a Roux-en-Y limb. This approach both restricts the stomach size and diverts food away from absorptive mucosa in the small intestine.

"Billopancreatic diversion" (C) limits the normal absorption of food since pancreatic secretions and bile are diverted farther down the small intestine. This means that absorption will only occur in the distal part of the small intestine. The stomach can be resized or left as is.

Generally, about 75% of patients who receive bariatric surgery go on to lose a significant amount of weight permanently. I'll continue in the next few posts to discuss the benefits and risks of the surgeries as well as the neuropeptides involved in hunger, eating, and feeling full. Stay tuned!

Prefereably bariatric surgery should be preformed laparoscopically

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Laparoscopic techniques are used in orthopedic, obesity and bariatric surgical procedures, cosmetic surgery fields, cardiac or heart care and chronic disease treatments, among others.

Not to be pedantic, but phrases along the lines "our bodies weren't designed to do x". They weren't designed at all. Our bodies didn't *evolve* to do x.

SB: Point taken.

I see this kind of surgery as a symptom of our society. Nobody wants to take responsibility for their actions(overeating) and they want a "quick" and "easy" fix for the weight gain that results. I find it bizarre that people think that having major surgery is "easier" then putting down the bigmac and going for a walk.

It really boggles my mind that there are people that believe overweight people are that way by choice. The societal pressures for being thin are incredible. I assure you that 99% of people who are overweight have tried "putting down the bigmac and going for a walk." [sic]

I don't understand why it's socially acceptable to have fun at the expense of fat people. Would you tell a person with anorexia they should go find a big mac, or an alcoholic to just put down the bottle and get over it?

The true symptom of our society is the need to judge people, the need to think it's somebody else's responsibility, if it isn't bothering me I don't care, not in my back yard, etc.

Did it ever occur to you that these people are taking responsibility? It is neither a "quick" or "easy"--or cheap--fix, there are risks involved, and there are drastic changes people need to make in their lives and lifestyles before and after undergoing a procedure such as this.

Unless someone has an actual medical condition that would prevent it, adjusting diet and increasing activity is the BEST way to lose weight. Far better then throwing your hands up and saying "I just can't lose weight" and opting for surgery. Most people who say they've tried "everything" haven't really made one honest effort yet. More then likely they tried some foolish gimmick diets or some other quack diet aids. Unless you have a medical condition, weight control is actually very simple. Calories in versus calories out. If you eat more calories then your body can use in a day, you gain weight. If you burn off more calories in a day then you take in, you lose weight. It's very simple. That's all that surgery does anyways, it restricts how many calories you can consume at a time. Does it make more sense to just watch the calories you eat or to have a surgeon physically alter your body to FORCE you to consume fewer calories?

I'm not making fun of anybody by pointing that out. Nor is it societies fault when someone consumes 5k-6k calories a day and ends up weighing 400+lbs. I used to weigh over 300 pounds and my weight was nobody's fault but my own. I now weigh less then 200 pounds and I workout several days a week and watch my diet. I took responsibility for my weight and my health. I put down the bigmac and went for a walk(now I run 2-4 miles a day instead of walking).

I fail to see how you think I'm attacking "fat people" when all I'm doing is pointing out the obvious.

Pictures like these would usually make me gag. Nevertheless, it was very interesting to read this over.

Boosterz: way to go.

it's interesting how easy moral judgments can be made regarding obesity and obesity surgery. Here's my two (or three) cents.

1) we are inherently "calorie-thrifty" organisms living in a calorie-abundant environment. It only takes an excess 30 calories a day, every day, to put on a couple hundred pounds over the course of a lifetime (that snickers is about 300 calories; put it down now).

2) our bodies aggressively resist lowering a body mass "set-point" once it has been established, through a variety of mechanisms I'm sure Shelley will talk about later.

3) While Boosterz story is inspiring, most people are not capable of success like that. S/he is truly an exception to the majority.

4) As a society, we think nothing of putting a hip joint into a 70-year old so they can continue playing tennis; that (expensive and elective) surgery presumably maintains their quality of life. Performing gastric bypass can permanently reduce the weight of a morbidly obese person by 1/3, eliminate their diabetes, remove their inability to sleep at night, allow them to work a regular job... THAT is a true improvement in quality of life. We don't judge that septegenarian for wanting to keep her quality of life; why do we judge fat people for wanting to improve theirs?

Think before you comment.