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Obesity Can be Much More Risky than Weight Loss Surgery

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About Obesity

Obesity is a condition in which the natural energy reserve, stored in the fatty tissue of humans and other mammals, exceeds healthy limits. It is commonly defined as a body mass index (BMI) (weight divided by height squared) of 30 kg/m2 or higher.

Mortality is increased in obesity, with a BMI of over 32 being associated with a doubled risk of death.  Central obesity (male-type or waist-predominant obesity, characterized by a high waist-hip ratio), is an important risk factor for the metabolic syndrome, the clustering of a number of diseases and risk factors that heavily predispose for cardiovascular disease. These are diabetes mellitus, Type 2 diabetes mellitus, high blood pressure, high blood cholesterol, and triglyceride levels (combined hyperlipidemia).

Apart from the metabolic syndrome, obesity is also correlated with a variety of other complications. For some of these complaints, it has not been clearly established to what extent they are caused directly by obesity itself, or have some other cause (such as limited exercise) that causes obesity as well. The affected health conditions include but are not limited to:

Cardiometabolic Risk

Cardiometabolic risk (CMR) goes beyond metabolic syndrome. Cardiometabolic risk encompasses a cluster of modifiable risk factors and markers that identify individuals at increased risk of cardiovascular disease (myocardial infarction, stroke, peripheral arterial disease), and Type 2 diabetes mellitus.

Cardiometabolic Risk Factors

Cardiometabolic risk (encompasses a cluster of modifiable classic and emerging risk factors and markers that identify individuals at increased risk for cardiovascular disease (CVD) and type 2 diabetes.

CMR includes the factors that make up the National Cholesterol Education Program's Adult Treatment Panel III (ATPIII) definition of metabolic syndrome and also includes four additional factors: smoking, elevated LDL-C, inflammatory markers and insulin resistance.

Comparing Cardiometabolic Risk (CMR)  vs. Classic Metabolic Syndrome

 Metabolic Syndrome (ATPIII) consists of any 3 of the following:

Triglycerides (mg/dL)
≥150
HDL-C (mg/dL)  
  • Men
  • Women
<40

<50
Blood pressure (mm Hg)
≥130/≥85
Fasting glucose (mg/dL)
≥110
  • Men
  • Women
>40

>35

Obesity increases risk factors associated with several diseases as noted above, all which increase mortality due to cardiovascular disease (CVD). 

Bariatric Surgery Risk Analysis

Because life threatening health risks from obesity increases with a person's waist size, many health care professionals are now in agreement that the benefits from weight loss surgery far outweigh the risks of complications for obese individuals, especially those with several CMR risk factors.

Besides dramatically lowering CVD risk, and risks for: 

Another health benefit of bariatric weight-loss surgery may be a heightened immune defense against cancer and infections, according to Dr. Alfredo Halpern, PhD, of the University of São Paulo, Brazil.

“Weight loss surgery may also help protect against infections and cancer by improving the activity of certain immune cells,” Halpern said. Cancers that research has linked to obesity include colon cancer, breast cancer, endometrial cancer, and kidney cancer.

Types of Weight Loss Surgery

Weight loss operations generally fall into three basic categories:

  • Malabsorptive techniques reduce the amount of intestine that comes in contact with food so that the body absorbs fewer calories   
  • Restrictive procedures make the stomach smaller to limit the amount of food intake
  • Combination operations employ both restriction and malabsorption

Restriction Weight Loss Operations

Restrictive weight loss operations are the least commonly performed. They encourage weight loss two ways:   

  • Reducing the amount of food that can be eaten. This is done by reducing the size of the stomach by creating a small pouch at the top of the stomach where food enters from the esophagus. This makes it impossible for the patient to each much since the pouch only holds about 1 ounce of food. It expands to hold 2-3 ounces over time.  One of the many drawbacks to this procedure is by shrinking the stomach to such a small size, getting the required nutrients through food can be challenging.
  • Slowing the speed of which food empties from the stomach. The lower outlet of the pouch is only about 1/4 inch in diameter (vs. a normal unrestricted size opening). Because it's so small, food empties slowly, leaving a sense of fullness longer.  This increases satiety, which in urn decreases hunger and the need to eat additional food.

Types of Restrictive Weight Loss Operations:

  • Vertical banded gastroplasty. This common procedure creates the pouch with both a band and staples.
  • Gastric banding (laparoscopy aka "lapband").  Laparoscopy (lapband) is a minimally invasive surgical technique where a silicone gastric band placed around the top of the upper part of the stomach.  A band of special material is placed around the upper end of the stomach. This creates a small pouch and narrow passage into the rest of the stomach. It works by  helping you control your food intake and supporting long term, sustainable weight loss.

Laparoscopic Weight Loss Surgery

Although open surgeries are the most common treatment methods for obesity many surgeons are now beginning to offer the less invasive laparoscopic procedure whenever possible. The less invasive procedure is being more routinely prescribed earlier in the obesity process (for patients before  body mass index (BMI) rise). It has become a preferred method in the battle against obesity because patients who have had laparoscopic weight loss surgery experience:   

  • Less pain after surgery  
  • Easier breathing and lung function
  • Fewer wound complications such as infection or hernia
  • Quicker return to pre-surgical levels of activity.

Gastric Bypass Weight Loss Operations

Gastric bypass surgery is a more invasive surgical procedure that alters the process of digestion.

There are several types of gastric bypass procedures, but all of them involve bypassing part of the small bowel by greater or lesser degrees. For this reason, procedures of this type are referred to as malabsorptive procedures, because they involve bypassing a portion of the small intestine that absorbs nutrients.

Some of the gastric bypass weight loss  procedures also involve stapling the stomach to create a small pouch that serves as the “new” stomach or surgically removing part of the stomach.

Depending on the specific weight loss procedure used, the gastric bypass procedure can be considered both restrictive and malabsorptive because the size of the stomach is reduced so that the amount of food that can be eaten is “restricted” due to the smaller stomach. It is important to note that weight loss procedures that are restrictive and malabsorptive carry more risk for nutritional deficiencies.

Main Types of Gastric Bypass Weight Loss Procedures

Roux-en-Y Gastric Bypass (RGB)

Roux-en-Y gastric bypas is the  most common bariatric procedure today. This procedure involves creating a small stomach pouch with staples or a vertical band to shrink the stomach and restrict food intake. The surgeon then attaches a Y-shaped section of the small intestine to the pouch to allow food to bypass the first section of the small intestine (the duodenum) and the second section of the small intestine (the jejunum) reducing body's ability to absorb nutrients and calories. The effect of bypassing these sections of the intestine is to restrict the amount of calories and nutrients that are absorbed into the body.Because this weight loss procedure is both malabsorptive and restrictive it can result in rapid weight loss.

Note: the Roux-en-Y gastric bypass may also be performed with a laparoscope rather than through an open incision in some patients. This procedure uses several small incisions and three or more laparoscopes - small thin tubes with video cameras attached - to visualize the inside of the abdomen during the operation. The surgeon performs the surgery while looking at a TV monitor. The laparoscopic method allows the physician to make a series of much smaller incisions. Laparoscopic gastric bypass can speed recovery. It also allows for future adjustment of the size of the pouch, leading to flexiblity for allowing nutrient absorption. Laparoscopic gastric bypass usually reduces the length of hospital stay, the amount of scarring, and results in quicker recovery than an open procedure.

Distal Gastric Bypass (Duodenal Switch, Biliopancreatic Division)

During Distal Gastric Bypass a portion of the stomach is removed. The remaining small pouch is then directly connected to the last portion of the small intestine (the jejunum)

A distal gastric bypass weight loss procedure (aka  biliopancreatic diversion) is both restrictive and malabsorptive, and is a more complicated procedure than the Roux-en-Y procedure. This can result in higher surgical risk, longer recoveries and greater risk to the patient. The risk for nutritional deficiencies is also highest with this procedure, because the food is completely bypassing the first section of the small intestine (the duodenum). For these reasons this weight loss surgery is not as commonly performed as the other weight loss procedures. Note, a variation of the biliopancreatic diversion is a procedure called the duodenal switch. More of the stomach is retained, including the valve that controls the release of food into the small intestine. A small part of the duodenum is also retained.

Comparing the Procedures

Risks are similar for both restrictive and gastric bypass procedures. Except the risk of nutritional deficiencies for iron, calcium, and Vitamin B12--are higher in patients who undergo gastric bypass operations.

Patients generally have more success with gastric bypass operations than restrictive procedures. However for patients with lower BMIs the lapband surgeries may prove to be the best choice because of the quicker recover, and less surgical risk. 

With gastric bypass operations there is risk of intestinal leaking and potential risk for  "dumping syndrome."  "Dumping syndrome" refers to when food moves too fast through the small intestine. It causes nausea, weakness, sweating, faintness, and sometimes diarrhea.

Patients often recover quicker with the laparoscopic surgery (e.g., Lapband and Realize Band), however there are risks associated with this surgery as well, such as the regular surgical risks, as well as band slippage.

About the Author

Jeff Behar
Jeff Behar, MS, MBA
Jeff Behar, MS, MBA is a recognized health, fitness and nutrition expert, regularly writing about hot topics in the areas of health, fitness, disease prevention, nutrition, anti aging and alternative medicine. His work also often appears in several of the major health and fitness newsletters, health and fitness magazines, and on major health, and fitness websites. Behar is also a well sought after personal trainer, motivational speaker, and weight loss expert.

 

 

Last modified on Thursday, 03 December 2009 15:06
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