Weigh the Options
Obesity is a serious health problem. Bariatric surgery can help morbidly obese patients, but you should carefully consider the benefits and risks. By Rear Adm. Joyce Johnson, D.O

Bariatrics is the medical specialty of treating obesity (defined as having a body mass index (BMI) of 30 or higher). The BMI is calculated based on weight and surface area; height is often used to approximate surface area. About one-fourth of adult Americans are defined as obese; about 3 percent are morbidly so.

The most commonly used bariatric surgical procedures are gastric bypass and gastric binding. Both procedures can have significant complications and require lifelong medical follow-up as well as a commitment to healthy eating and regular exercise. The average weight of someone who undergoes bariatric surgery is close to 300 pounds; three-fourths of patients have a BMI over 40, and most are at least 100 pounds overweight.

Bariatric surgery alters the anatomy and digestive pathways. When we eat, food goes from our mouth to the stomach through a long tube, the esophagus. Food is partially digested in the stomach, and from there it goes to the intestines, where digestion and absorption of nutrients is completed.

Gastric bypass involves surgically creating a small pouch from a portion of the stomach at its junction with the esophagus. This pouch is connected directly to the small intestine, bypassing the stomach and part of the intestine. The pouch, about the size of an egg, holds less food than the stomach, and the opening between the pouch and the intestine is small, so food leaves it slowly. The usable length of the small intestine also may be shortened. These factors all contribute to less food consumption and absorption, and thus lead to weight loss.

With gastric binding, a band is placed surgically around the stomach near the esophagus to make a pouch that functions as a small stomach. Unlike gastric bypass surgery, which is irreversible, the band can be adjusted or removed. Someone with such a pouch might only be able to eat 1⁄2 cup or less of food at each meal before feeling full.

Candidates for bariatric surgery include those who remain obese after trying diets and more conventional weight-loss approaches. Surgery could be indicated if excess weight leads to other medical complications, such as high cholesterol, high blood pressure, or heart or lung disease, or when weight interferes with daily life activities — for example, some morbidly obese people are no longer able to walk.

However, bariatric surgery can have many complications, including diseases resulting from poor nutrition such as protein deficiency, vitamin B-12 deficiency, anemia, and osteoporosis. (Many nutritional deficiencies can be managed with supplements.) Vomiting and diarrhea are also common side effects. About one-fifth of patients need additional surgeries for hernias and other problems.
 

— Rear Adm. Joyce Johnson, USPHS-Ret., D.O., M.A., is vice president, Health Sciences, Battelle Memorial Institute, Arlington, Va. Find more health and wellness resources online at www.moaa.org/wellness.