Once an individual becomes obese, a lifestyle change is vital due to the corresponding health risks--including heart disease, stroke and diabetes. If diet and exercise do not work alone, another procedure--surgery--can be used as a last resort, says Patricia Gregory, a dietitian from Optimal Weight--a weight loss clinic in Gainesville, Fla.

"It's a good option to have available," Gregory says. "It's unfortunate, though, we have a society where so many people get there."

Surgery Candidates

Bariatric (weight loss) surgery, the most extreme action against obesity, according to Gregory, can only be considered once an individual has put forth an honest effort to lose weight. Candidates for surgery include those who weigh twice their healthy weight - or at least 100 pounds more than their healthy weight - have been overweight for more than 5 years, or have made serious weight-loss attempts and are prepared to make substantial changes in their lifestyle. In order to determine your healthy weight, calculate your Body Mass Index (BMI)--based on your height and weight. If an individual reaches the criteria, he or she needs to get a physician's note and--in most cases--speak with a psychologist to make sure to understand this is a life-style change.

"Most insurances require that they have a physicians note saying they have been followed for a while and they've tried a number of different things," Gregory says. "The BMI minimum for surgery is 40."

Once someone has met the criteria and has a physician's approval, that person has a decision to make. Two types of bariatric surgery, laparoscopic adjustable gastric banding and gastric bypass, are performed today.

Types of Surgery

Laparoscopic adjustable gastric banding uses a silicone band lined with an inflatable balloon. The band is placed around the patient’s stomach. When the balloon is inflated, the silicone band tightens. As the band tightens, the less food it takes to fill up the patients shrinking stomach, which results in weight loss.

Gastric bypass, according Gregory, is more complex because it changes your anatomy. A part of the intestine is connected to a bile-preventing pouch--eliminating bile reflux--that enters the upper part of the stomach and esophagus, according to the American Society for Bariatric Surgery. The rest of the stomach and the first part of the small intestine are bypassed. This procedure decreases the size of the patient's stomach, which results in weight loss. Initially this procedure was done as a full surgical procedure, but doctors now perform it laparoscopically.

The laparoscopic adjustable gastric banding is reversible, but gastric bypass is not.

"There's an initial much faster weight loss with gastric bypass," Gregory says. "The recovery for the gastric bypass is longer."

Advantages and Risks of the Surgeries

(From the American Society for Bariatric Surgery's Web site)


Audio







Patricia Gregory, a dietitian from Optimal Weight—a weight loss clinic in Gainesville, Fla.—explains bariatric surgery requirements and procedures.



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