Diet and Weight Loss Weight Loss Surgery

Weighing the Decision to Have Obesity Surgery

Having surgery to alter the way you digest your food is not a decision to be taken lightly. But it is one that more and more people who are severely obese are weighing now that safer and more effective obesity surgery is available to them.

About 3 percent of American adults are considered severely obese. People are considered severely obese when they have a body-mass-index (BMI), a measurement that compares your weight and height, of 40 or more. This usually means they are about 100 pounds overweight.

People who are this heavy are often disabled by their extra weight and face a host of medical conditions and even a shortened lifespan. But surgery can be lifesaving, says Marc Bessler, MD, FACS, the director of the New York–Presbyterian Center for Obesity Surgery at Columbia University Medical Center.

"There are centers doing safe operations with good results and anybody who's suffering with this disease needs to at least think about it," Dr. Bessler explains.

If someone decides to have surgery, they will need to figure out which operation is best for them and whether they will be able to adopt new eating habits after a surgery that has made their stomach smaller and/or changed the way that their body absorbs food. Read on for Dr. Bessler's review of the risks and benefits of the different surgical options, including laparoscopic gastric banding, also know as Lap-Band, and gastric bypass.

Who is a candidate for obesity surgery?
It depends on the type of surgery, but the standard criteria are being 100 pounds over ideal body weight or 80 pounds over ideal body weight if someone also has medical conditions due to the obesity, such as diabetes, high blood pressure, sleep apnea syndrome or others.

Pretty much anybody who is going to be accepted for surgery will have tried and failed to maintain weight loss with diet. They also won't have any absolute contraindications to surgery, such as uncorrectable bleeding disorders, unmanaged psychiatric disorders or active drug abuse or alcoholism. They will understand what they need to do after surgery and be willing to make the lifestyle changes that these operations require. They will commit to long-term follow-up.

What are the leading types of surgery?
The most common surgery for obesity is gastric bypass. Probably the next most common surgery in the United States is adjustable gastric banding, which is a safer operation but doesn't achieve as much weight loss and requires a little bit more work on the patient's part.

Both operations can be done laparoscopically. That means making five or six small incisions in the abdomen and a inserting a scope to visualize and perform the operation. There's another procedure called biliopancreatic diversion, or duodenal switch, which is more complex than either of those and isn't very commonly performed.

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