February 9, 2018
Obesity is a common medical condition that affects more than one-third of U.S. adults (1). The treatment for obesity includes nutrition, physical activity, behavioral changes, and anti-obesity medications. In patients whom medical treatment is not enough, surgical treatments may be needed as well. Weight loss surgery is usually reserved for patients with a BMI over 40, or with a BMI over 35 with an obesity-related condition, such as diabetes or high blood pressure. There are several weight loss surgical options as well as a few newer, less invasive procedures; some of the newer procedures are approved for patients with a BMI over 30. The benefits and risks of each surgical option must be evaluated by an experienced bariatric surgeon and individualized to each patient.
Roux en Y Gastric Bypass
Often referred to simply as “gastric bypass,” Roux en Y gastric bypass was initially developed in the 1960s after weight loss was observed in patients who underwent a partial stomach removal for gastric ulcers (2). The surgery involves creating a small pouch in the stomach and then connecting the pouch to the intestine, bypassing part of the intestine where some nutrients from food are absorbed. This results in reducing the amount of food that can be eaten at one time and reducing the calories that can be absorbed from that food. Gastric bypass has been performed for decades and is one of the most efficacious treatments for obesity.
Sleeve gastrectomy has recently become one of the most commonly performed bariatric surgeries in the United States. The surgeon permanently removes a large portion of the stomach, reducing the stomach size to about 25% of its original size (3). This results in reducing the amount of food that can be eaten at one time.
Adjustable Gastric Banding
While this procedure used to be performed quite commonly, it is performed less frequently now in favor of other procedures. The surgery involves placing an inflatable silicon band around the stomach to create a small pouch, thereby limiting the amount of food that can be consumed at one time. After the band is placed, the patient has follow-up visits to either inflate or deflate the band depending on the amount of restriction needed.
Biliopancreatic Diversion with Duodenal Switch
This surgery is like a combination of sleeve gastrectomy and gastric bypass, and it is the most complicated and aggressive surgical treatment. First, a large portion of the stomach is removed. Then, the duodenum and a large part of the small intestine is bypassed and the small remaining portion of the stomach is connected to the intestine (4). This limits how much food can be consumed at one time and significantly decreases the calories and nutrients that are absorbed by the intestine.
Endoscopic Sleeve Gastroplasty
This is a newer and less invasive procedure offered to patients with a BMI over 30. Using an endoscope, the physician accesses the stomach through the patient’s mouth and uses a suturing device to reduce the size of the stomach.
This is also a newer, temporary, nonsurgical procedure in which one to three deflated balloons are swallowed and then inflated in the stomach. This results in an earlier feeling of fullness after a small amount of food is consumed. After six months, the balloons are removed endoscopically.
Surgical treatments for obesity must be combined with permanent healthy changes in nutrition, physical activity, and behavior in order to be effective. Additionally, weight loss surgery and anti-obesity medications are now frequently used in combination to achieve greater weight loss and prevent weight regain (5).
- cdc.gov. Accessed 1/10/2018
- asmbs.org. Story of Obesity Surgery. Accessed 1/10/2018.
- clevelandclinic.org. Gastric Sleeve Surgery. Accessed 1/10/18.
- houstonweightlossuthealth.com. Duodenal Switch Bariatric Surgery. Accessed 1/10/2018.
- “The utility of weight loss medications after bariatric surgery for weight regain or inadequate weight loss: A multi center study”. Stanford, Fatima Cody et al. Surgery for Obesity and Related Diseases. March 2017.
This article was written by Katherine Duncan, MD. Dr. Duncan is an obesity medicine physician at Scottsdale Weight Loss Center in Arizona.
Photo courtesy of the Canadian Obesity Network.