The Emory Bariatric Center offers a multi-disciplinary strategy to combat obesity utilizing physicians, psychologists, dietitians, exercise specialists, medical services and surgery when appropriate.

Surgical Weight Loss
How Does Surgery Promote Weight Loss?
Bariatric Procedures Performed at Emory
Explore Benefits and Risks
Is Surgery the Option for You?
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While severe obesity is a chronic condition that is very difficult to treat, surgery to promote weight loss by restricting food intake or interrupting the digestive process is a valid option for those that are critically obese. According to NIH guidelines, surgery is justifiable for those with a Body Mass Index (BMI) above 40, translating to approximately 100 pounds overweight for men and 80 pounds for women. Surgery can also be a valid choice for patients with a BMI between 35 and 40 who suffer from obesity-related chronic or life-threatening complications, such as severe sleep apnea, heart disease or diabetes. In an effort to ensure the best possible outcomes, Emory Bariatric Center requires a BMI below 55 to qualify as a surgical candidate, making preoperative weight loss mandatory for some patients. As in non-surgical treatments for obesity, successful results greatly depend on motivation and behavior.

Recently on WebMD, Julie Schwartz, the Emory Bariatric Center's dietitian, appeared in a video detailing the results of surgical and non-surgical weight management in three patients. While the benefits of these weight reducing methods are described, Julie in particular cautions that weight regain can occur if patients don't alter their eating habits and prior lifestyle.     

The concept of stomach surgery to control severe obesity began developing when the results of operations for cancer or severe ulcers that removed large portions of the stomach or small intestine were examined. The patients tended to lose weight, influencing some physicians to use such operations to treat severe obesity. Intestinal bypass, initially performed 40 years ago, was the first widely-used operation for severe obesity and produced weight loss by causing caloric malabsorption. The intention was to cause poor digestion or to accelerate the digestive process too quickly for the patient's body to absorb many calories, though it was also assumed that the procedure would allow patients to eat as much as they wanted. Unfortunately, the surgery actually resulted in a notable loss of essential nutrients while also causing unpredictable and occasionally fatal side effects. The original form of this operation is no longer used.

Surgeons now apply laparoscopic techniques that produce weight loss primarily by limiting how much food the stomach can hold. These restrictive procedures are often combined with minimally invasive bypass methods that partially limit calorie and nutrient absorption and may lead to altered food choices.

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Patients should carefully weigh the risks and benefits of their treatment options before choosing either of the two laparoscopic bariatric procedures offered at the Emory Bariatric Center. While these major operations do lead to weight loss in almost all patients, weight regain can occur.

• Lap Band System
  Also known as gastric banding, this procedure involves the placement of a band made of special material around the stomach near the upper end, creating a small pouch and a narrow passage into the larger remainder of the stomach to limit food consumption. Patients feel full more quickly, causing them to eat less and lose weight.
  
  
• Gastric Bypass
  In addition to restricting food intake by creating a stomach pouch, this method induces reduced calorie and nutrient absorption (malabsorption) by diverting food from the first segment of the small intestine, typically producing significant weight loss. Following gastric bypass, most patients generally lose two-thirds of their excess weight within two years.
  
  
• Sleeve Gastrectomy
  Involving the laparoscopic removal of approximately 75 percent of the stomach, leaving the remainder shaped like a long tube or sleeve, this procedure restricts food intake without intestinal bypass or malabsorption.

Successful, sustained results after surgery depend on motivation, controlling potentially damaging behaviors, and sustaining a lifelong commitment to nutritional counseling and care. There have been instances where patients were unable to adjust their eating habits and failed to lose the desired weight or to maintain the loss.

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Since bariatric surgery is a considerable undertaking, it is essential that patients and their physicians carefully consider the following benefits and risks:

Benefits

• Immediately following surgery, many patients lose weight rapidly and continue to do so for 18 to 24 months. Most regain some of their lost weight after this period, though few regain it all.
  
  
• Surgery improves most obesity-related conditions. For example, one recent study showed that the blood sugar levels of most diabetic patients returned to normal after weight-loss surgery. Nearly all of those whose blood sugar levels did not normalize were older or had been diabetic for some time, suggesting that early intervention for obesity can control obesity-related diabetes.

Risks

• Ten to 20 percent of patients who have weight-loss operations require follow-up procedures to correct complications, abdominal hernias being the most common. Breakdown of the staple line and stretched stomach outlet are less common. Laparoscopic surgery may decrease the incidence of hernias if performed by surgeons with advanced skills.
  
  
• Following weight loss surgery, more than one-third of patients develop gallstones due to rapid or substantial weight loss. Surgical removal may be necessary.
  
  
• Nearly 30 percent of patients who have weight-loss surgery develop nutritional deficiencies such as anemia, osteoporosis and metabolic bone disease, though these conditions can be avoided with vitamin and mineral supplements.
  
  
• Since rapid weight loss and nutritional deficiencies can harm a developing fetus, female patients of childbearing age should avoid pregnancy until their weight stabilizes.

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For those patients who remain severely obese after attempting non-surgical weight-loss or who have an obesity-related disease, surgery may be appropriate. Conversely, greater efforts toward weight control may be more suitable for other patients, such as changes in eating habits, behavior modifications and increased physical activity. The following questions can assist in deciding whether or not you should pursue surgical options:

Are You:

• Unlikely to lose weight successfully with additional non-surgical measures?
  
  
• Well informed about the particular surgical procedure and the effects of treatment?
  
  
• Determined to lose weight and improve your health?
  
  
• Aware of how your life may change after the operation?
  
  
• Willing to make adjustments to the side effects of surgery such as having to chew thoroughly and being unable to eat large meals?
  
  
• Aware of the potential for serious complications, the associated dietary restrictions and the occasional failures?
  
  
• Committed to lifelong medical follow-up?

Do You:

• Have a BMI of 40 or more or a BMI between 35-40 with co-morbidities such as heart disease or diabetes?
  
  
• Have an obesity-related physical problem such as a body size that interferes with employment, mobility or family function?
  
  
• Have high-risk, obesity-related health problems such as severe sleep apnea or obesity-related heart disease or diabetes?
  
  
• Have good emotional and psychological support from family and/or friends?

Remember: There are no guarantees that any of the available surgical or non-surgical methods will produce and maintain weight loss. Success is possible only with complete and lifelong cooperation and commitment to behavioral change and medical follow-up.

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To learn more about the surgical options offered by the Emory Bariatric Center, please call Emory HealthConnection at 404.778.7777 or 1.800.75.EMORY (1.800.753.6679) to register for a free, informational seminar.

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