To understand how surgical procedures aid the grossly overweight
person to reduce their body fat, it helps to first understand
the digestive process that is responsible for handling the food
we take in.
Once food is chewed and swallowed, it's on its way through the
digestive tract, where enzymes and digestive juices will break
it down and allow our systems to absorb the nutrients and
calories. In the stomach, which can hold up to three pints of
material, the breakdown continues with the help of strong acids.
From there it moves into the duodenum, and the digestive process
speeds up through the addition of bile and pancreatic juices.
It's here, that our body absorbs the majority of iron and
calcium in the foods we eat. The final part of the digestive
process takes place in the 20 feet of small intestine, the
jejunum and the ileum, where calorie and nutrient absorption is
completed, and any unused particles of food are then shunted
into the large intestine for elimination.
Weight loss procedures involve bypassing, or in some way
circumventing the full digestive process. They range from simple
reduction of the amount you can eat, to major bypasses in the
digestive tract. To qualify for many of these surgeries, a
person must be termed "morbidly obese", that is, weighing at
least 100 lbs. over the appropriate weight for their height and
general body structure.
Gastric Bypass
In the mid 1960s, Dr. Edward E. Mason discovered that women who
had undergone partial stomach removal as the result of peptic
ulcers, failed to gain weight afterwards. From this observation,
grew the trial use of stapling across the top of the stomach, to
reduce its actual capacity to about three tablespoons. The
stomach filled quickly, and eventually emptied into the lower
portion, completing the digestive process in the normal way.
Over the years, the surgery evolved into what is now known as
the Roux-en-y Gastric Bypass. Instead of partitioning the
stomach, it is divided and separated from the rest, with
staples. The small intestine is then cut at approximately 18"
below the stomach, and attached to the "new", small stomach.
Smaller meals are then eaten, and the digested food moves
directly into the lower part of the bowel. As weight loss
surgeries are viewed overall, this is considered one of the
safest, offering long-term management of obesity.
Gastric Banding
A procedure that produces basically the same results as the
stomach stapling/bypass, and is also classed as a "restrictive"
surgery. The first operations, involved a non-flexing band
placed around the upper part of the stomach, below the
esophagus, creating an hourglass shaped stomach, the upper
portion being reduced to the same 3-6 ounce capacity. As
technologies advanced, the band became more flexible,
incorporating an inflatable balloon, which when triggered by a
reservoir placed in the abdomen, was capable of inflating to cut
down the size of the stoma, or deflating to enlarge it.
Laparoscopic surgery means smaller scars, and less invasion of
the digestive tract.
Biliopancreatic Diversion
A combination of the gastric bypass, and Roux-en-y
re-structuring, that bypasses a significant section of the small
intestine, thereby creating the probability of malabsorption.
The stomach is reduced in size, and an extended Roux-en-y
anastomosis is attached to the smaller stomach, and lower down
on the small intestine than is normal. This permits the patient
to eat larger amounts, but still achieve weight loss through
malabsorption. Professor Nicola Scopinaro, University of Genoa,
Italy, developed the technique, and last year published the
first long-term results. They showed an average 72% loss of
excess body weight, maintained over 18 years, the best long-term
results of any bariatric surgical procedure, to date. BPD
patients require lifelong follow-ups to monitor calcium and
vitamin intake. The advantages of being able to eat more and
still lose weight, are countered by loose or foul smelling
stools, flatus, stomal ulcers, and possible protein malnutrition.
Jejuno-Ileal Bypass
One of the first weight loss procedures for the grossly obese,
was developed in the 1960s, a strictly malabsorptive method of
reducing weight, and preventing gain. The jejuno-ileal bypass
reduced the lower digestive tract to a mere 18" of small
intestine, from the natural 20 feet, a critical difference when
it came to absorption of calories and nutrients. In the
end-to-end method, the upper intestine was severed below the
stomach, and re-attached to the small intestine much lower down,
which had also been severed, thereby "cutting out", the majority
of the intestine. Malabsorption of carbohydrate, protein,
lipids, minerals and vitamins, led to a variation, the
end-to-side bypass, which took the end of the upper portion, and
attached it to the side of the lower portion, without severing
at that point. Reflux of bowel contents into the non-functioning
upper portion of small bowel, resulted in more absorption of
essential nutrients, but also less weight loss, and increased
weight gain, post-surgery. As a result of the bypass, fatty
acids are dumped in the colon, producing an irritation that
causes water and electrolytes to flood the bowel, ending in
chronic diarrhea. The bile salt pool necessary to keeping
cholesterol in solution is reduced by malabsorption and loss
through stool. As a consequence, cholesterol concentration in
the gall bladder rises, increasing the risk of stones. Multiple
vitamin losses are a major concern, and may result in bone
thinning, pain and fractures. Approximately one third of
patients experience an adjustment in the size and thickness of
the remaining active small intestine, which increases the
absorption of nutrients, and balances out the weight loss.
However, over the long term, all patients undergoing this bypass
are susceptible to hepatic cirrhosis. In the early 1980s, one
study showed that approximately 20% of those who had undergone
JIB, required conversion to another bypass alternative. The
procedure has since been largely abandoned, as having too many
risk factors.
While surgical methods of reducing weight are valuable to the
morbidly obese, they are not without risks. Patients may require
more bed rest post-surgery, resulting in an increased chance of
blood clots. Pain may also cause reduced depth of breathing, and
complications such as pneumonia.
Before undergoing any fat/weight reduction surgery, a severely
overweight person needs to thoroughly understand the benefits
and risks, and must make a commitment to their future health.
Having a smaller stomach is not going to stop the chronic
sugar-snacker, from "grazing" on high calorie sweets. Nor does a
steady supply of pop, concentrated sweet juices and milk shakes,
reduce the calorie intake. With some bypass surgeries, certain
foods can aggravate side-effects that need not be that severe,
if common sense diets are adhered to. Surgery can be a
"shortcut" to weight loss, but it can also reduce your enjoyment
of life, if you are unable to adhere to the regimens that go
with it.
About the author:
Fitness Consultant Anthony Ellis has helped thousands of
individuals lose fat and build more muscle. To read more about
his fat loss recommendations please check out his site at
http://www.fatlosstips.com
