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Weight Loss Treatment

Weight Loss Treatment

Weight loss surgery also known as bariatric surgery is the treatment for people suffering with obesity. This will help people to lose weight and lower the risk of medical problems caused by obesity by maintaining the weight for longer period of time. Bariatric surgery can also help in improving morbid conditions like type 2 diabetes, hypertension, pain in the joints, sleep apnea, cardiac diseases, infertility problem etc. Bariatric surgery mainly contributes to weight loss in two ways:

1. Restriction -  it helps in limiting the amount of food stomach can hold which limits the calories consumed.
2. Mal-absorption - operation is used to bypass part of the small intestine that reduces the amount of calories that body absorbs.

Most surgeons use laparoscopic surgery method over traditional open surgery. Open surgery involves one single large incision in the stomach whereas in laparoscopic surgery, many tiny incisions are made and thin surgical tools are inserted through the cuts. Small scope attached to a camera that projects images onto a video monitor is also inserted in the body. Laparoscopic treatment involves less risk and complications and causes less pain and scarring than open surgery method. It may also lead to speedy recovery. But patient having a high level of obesity, had abdomen surgery before, or having any complex medical conditions may need open surgery which is a better option for them.

Bariatric surgery can be done in four ways:

1. Gastric bypass - also called Roux -en- Y gastric bypass are divided into two parts:

1) surgeon will create a small pouch in the upper section of the stomach which will make stomach much smaller in size. This way patient will eat less and feel satiated sooner. 2) Surgeon will cut the small intestine and attaches the lower part directly to the stomach pouch. Food will bypasses most part of the stomach and the upper part of small intestine so the body will absorb fewer calories. The surgeon will connect the bypassed part farther down to the lower part of the small intestine while the main part of the stomach will continue to make digestive juices. The bypass can also change gut hormones, bacteria, and suppress hunger by keeping satiated. This surgery is difficult to reverse. Some of the advantages of gastric bypass surgery are as follows:

a) Significant weight loss for longer period
b) Limits the amount food consumed
c) Conditions that increase energy consumed
d) Maintenance of excess weight loss
e) Makes person feel satiated and fuller

Apart from few advantages, gastric bypass surgery is more complex operation and can result in further complications. This also requires a restricted diet along with lifelong intake of vitamins and mineral supplements as gastric surgery can lead to long term vitamins/mineral deficiencies especially B12, folate, calcium and iron.

2. Sleeve Gastrectomy - surgeon will remove major part of the stomach leaving behind only a narrow banana shaped section of the upper part of the stomach that is closed with staples called gastric sleeve. The amount of food that can be fit in the stomach is reduced, making the patient feel more satiated sooner. This surgery has impact on gut hormones including hunger, satiety and blood sugar level. This surgery is quiet similar to gastric bypass surgery and effective in improving type 2 diabetes. Sleeve gastrectomy has some following advantages:

a) Limits the amount of food stomach can store.
b) Significant rapid weight loss
c) Requires no bypass or re-routing of the food path
d) Shorter stay at the hospital
e) Suppress hunger, appetite and keeps person satiated

This surgery is irreversible procedure and can cause long term vitamin deficiencies and early complications.

3. Laparoscopic adjustable gastric band - this surgery is performed using a laparoscope. The surgeon places a small band or a ring around the top of the patient’s stomach. The band has a small circular balloon inside filled with salt solution that controls how tight or lose the band is. Surgeon can adjust the size of the opening from the pouch to the rest of the patient’s stomach by injecting or removing the solution through a port (a small device) inserted under the patient’s skin. This band will restrict the amount of food in the stomach making the patient feel more satiated. Post surgery, patient may require several follow visits to adjust the size of the band opening and surgeon can also remove the band if it is not proving helpful in loosing enough weight or causing other problems.

4. Duodenal switch - is also known as biliopancreatic diversion with duodenal switch is more complicated than the other surgeries. This involves two separate operations. First surgery is similar to that of gastric sleeve surgery and in second surgery food is redirected to bypass most part of the small intestine. Surgeon will also reattach the bypassed part to the last section of the small intestine letting the digestives juices to mix with food. This can result in significant decrease in absorption of calories and nutrients. Similarly like in gastric bypass and sleeve gastrectomy, this surgery also affects gut hormones impacting hunger and blood sugar. This is the most effective surgery for controlling diabetes.

Patient needs to consult dietician, psychiatrists, psychologist and bariatric surgeon before undergoing the weight loss or bariatric surgery. Doctor will seek medical history of the patient, examine the patient physically and suggest few blood tests. Patient need to give up on smoking at least 6 weeks before the surgery and have to follow proper healthy diet recommended by dietitian. In some cases, patient need to lower their blood sugar level to normal and may also require to lose some weight that can cause problems related to surgery.

Patient may require a proper rest and medications or supplements like vitamins and minerals prescribed by doctors along with follow up visits. Moderate walking and movements as suggested by the doctor may help the patient to recover faster. The amount of weight loss after a bariatric surgery depends on person to person and the type of surgery performed.

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