Severe obesity is a chronic condition that is difficult to
treat through diet and exercise alone. Gastrointestinal surgery is an option
for people who are severely obese and cannot lose weight by traditional
means or who suffer from serious obesity-related health problems. The
operation promotes weight loss by restricting food intake and, in some
operations, interrupting the digestive process. As in other treatments for
obesity, the best results are achieved with healthy eating behaviors and
regular physical activity.
You may be a candidate for surgery if you have:
* a body mass index (BMI) of 40 or more—about 100 pounds overweight for men
and 80 pounds for women (see BMI
* a BMI between 35 and 39.9 and a serious obesity-related health problem
such as type 2 diabetes, heart disease, or severe sleep apnea (when
breathing stops for short periods during sleep)
* an understanding of the operation and the lifestyle changes you will need
The Normal Digestive Process
Gastric Bypass Surgery and
Body Mass Index Chart
Types of Gastric Bypass
Laparoscopic Bariatric Surgery
Bariatric Surgery for Adolescents
Is Gastric Bypass Surgery for
You? What is the cost of Gastric Bypass Surgery?
According to United Press International the number of U.S.
bariatric surgeries reportedly increased more than fivefold during the last
five years, from 13,386 during 1998 to 71,733 in 2002.
Bariatric surgery diminishes the size of a patient's
stomach, bypassing part of the intestines to reduce one's food absorption to
promote weight loss.
The July 12, 2005 report in the medical policy journal
Health Affairs said the potential demand for such surgeries is expected to
increase even further. Part of the reason for the recent increase has been a
lower postoperative patient death rate, down to 0.32 percent in 2002 from
nearly 1 percent in 1998, the report said.
But Dr. Christine Gerbstadt, an anesthesiologist and
dietitian in Altoona, Pa., told The Washington Times 20 percent of bariatric
surgery patients regain their weight, primarily because they do not change
their eating habits.
The report indicated the length of bariatric surgery
hospital stays fell 24 percent to 3.8 days during 2002, but the average cost
per surgery rose 13 percent from $11,705 during 1998 to $13,215 in 2002. The
Times said the report did not include more recent data.
The Centers for Disease Control and Prevention reports
about 64 percent of all U.S. adults are overweight or obese.
A report issued last year by HHS' Agency for Healthcare
Research and Quality (AHRQ) concludes that surgery for extremely obese
patients who have tried and failed to lose weight with exercise and diet may
be more effective for weight reduction. It can also improve control of some
obesity-related health problems such as high blood pressure and diabetes. In
addition, extremely obese persons—those who have a Body Mass Index (BMI) of
40 or greater—often suffer from severe health problems such as heart
disease, musculoskeletal disorders, and sleep apnea that limit daily
activities and put their lives at greater risk.
BMI can be calculated as weight in pounds divided by inches squared and then
multiplied by 703. An online BMI calculator can be found at
.A person who is 5 feet 8 inches tall and weighs 276 pounds
has a BMI of 42, for example, and is considered extremely obese.
Roughly 60 million adults in the United States are obese, and 9 million are
extremely obese. A BMI of 40 or greater is not the sole criterion for
selecting patients who might benefit from weight-loss surgery. Of the 9
million extremely obese adults, only a small fraction, about 1.5 percent or
140,000, undergo weight-loss surgery each year in the United States.
Approximately 20 percent of those who have weight-loss surgery experience
complications; although most are minor, some can be serious, according to
the study authors. These include nutritional deficiencies, leaks from staple
line breakdown, and deep vein thrombosis. Laparoscopic procedures result in
fewer wound complications and incision hernias than traditional abdominal
"Good nutrition and exercise are key elements of a healthy lifestyle and for
achieving a healthy weight," said AHRQ Director Carolyn M. Clancy, M.D. "For
adults whose health is severely compromised, using surgery to achieve weight
loss is an option, but is not a total solution or magic bullet for obesity.
Healthy behaviors have an important role in the management of obesity, even
for those who have surgery."
The scientific evidence review that was used as the basis for the new AHRQ
report found data suggesting that weight-loss surgery, also known as
bariatric surgery, may be more effective than drugs for people with BMIs of
35 to 40; however, the evidence is not strong enough to draw firm
conclusions for this group.
In addition, the review found that Roux-en-Y gastric bypass surgery results
in greater weight loss—an average of 20 pounds—than does vertical-banded
The AHRQ review did not find enough evidence to draw conclusions about
differences in the safety of different types of weight-loss surgery, which
include adjustable gastric banding, vertical-banded gastroplasty, and
biliopancreatic diversion procedures. Less than than 1 percent of patients
operated on by experienced bariatric surgeons die as a result of the surgery
or from complications, but the rate may be higher for less-experienced
The evidence review also found that some prescription medicines—particularly
orlistat and sibutramine, the most widely studied drugs—promote moderate
weight loss when prescribed along with recommendations for dieting. The
amount of weight loss directly attributable to these drugs averages less
than 11 pounds, but research shows that even such a modest weight loss may
decrease the occurrence of diabetes.
No weight-loss drug appears to be superior to others, and, like all
medications, each has side effects. The drugs have not been studied
sufficiently to evaluate the risk of rare side effects, nor has there been
enough research to determine the optimal time to treat obesity with drugs or
how this may vary by patients' age, gender, or race.
The evidence review found that very little research has been done on either
surgery or medical treatment of obesity in children and adolescents.
The report will be considered along with other information when the Medicare
Coverage Advisory Committee meets on November 4, 2004, to discuss the risks
and benefits of bariatric surgery in the Medicare population.
In December 2003, the U.S. Preventive Services Task Force recommended that
clinicians screen all adult patients for obesity and offer or refer obese
patients for intensive counseling and behavioral interventions to promote
sustained weight loss. The Task Force, which is supported by AHRQ, is the
leading independent panel of private-sector experts in prevention and
primary care and conducts rigorous, impartial assessments of the scientific
evidence for a broad range of preventive services