Surgery and Weight Loss

Surgery is used for those with a body mass index greater than 40 or for those with a BMI of 35 if afflicted with an at risk conditions such as sleep apnea, diabetes or heart disease.  In addition, the patient should have previous non-surgical attempts at weight loss. 

Surgery is classified in one of three ways: restrictive, malabsorptive, and combined restrictive and malabsorptive. Restrictive procedures decrease the amount of food that can be consumed and slows the transient time through the stomach. Malabsorptive procedures reduce the amount of calories that are absorbed in the digestive tract. 



With surgery, weight loss is often accomplished quickly. Long-term success after surgery is linked to the persons lifetime commitment to behavioral changes. Without continually working on the lifestyle changes the patient will not get the full benefit from the surgery.

Restrictive operations reduce food intake and do not impede the digestive process. The goal of the operation is to limit the amount of food that can be taken in. This type of procedure is safer than the malabsorptive operations.

A small pouch at the top of the stomach is made by the surgeon, which holds a very small amount of food. This pouch stretchs over time, but not usually more than a few ounces. The outlet is also small which slows down the rate at which food leaves the stomach and leads to a sense of fullness. If a lot of food is consumed there will be discomfort and nausea. Food must be well chewed, moist and soft.

Two common restrictive operations are adjustable gastric banding and vertical banded gastroplasty. The adjusted gastric banding places a silicone rubber band around the upper end of the stomach. The banding makes a small pocket and a thin passage to the stomach. An access port is placed so the band can be made more loose or tight with an infusion of salt water. The vertical banded gastroplasty uses staples and a band to create a small pocket.

While the restrictive operation is safer it is generally less effective than the malabsorptive operations. There is less weight loss over the first year and maintenance of weight loss is less likely. No matter which operation is chosen the patients ability to adapt a healthy lifestyle is the most critical factor to long-term weight loss.

Vomiting is a common side effect from the operation if one overeats. Slipping, breaking or wearing away of the band is a risk. Like any operation infections, bleeding or death can occur.