Required Reading for PreOps

This is an excellent article off of MSNBC.com today: Think twice about weight-loss surgery In many cases, the risks outweigh the benefits By Karen Collins, R.D. Registered Dietitian Special to MSNBC.com Updated: 11:06 a.m. ET Jan. 28, 2005 From 1993 to 2003, the number of weight-loss surgeries increased 500 percent. That number was predicted to increase even further in 2004. Since almost two-thirds of our population is now overweight or obese, thoughts about surgical procedures to reduce weight frequently cross people's minds. Yet misconceptions about them are common. People especially overlook all the necessary life changes for a successful operation. Liposuction, one type of weight-control surgery, may seem like a simple way to remove excess fat around the waistline, which is most associated with health risks like diabetes and heart disease. Yet in a recent study of obese women, liposuction that removed large amounts of waistline fat did not lower blood sugar and insulin levels or biomarkers of inflammation. Although removing fat deposits under the skin can significantly change a person's appearance, the health risks from excess weight appear to come from fat deep in the abdomen around or inside organs, which liposuction leaves in place. Unrealistic expectations Furthermore, a new study suggests that people who opt for liposuction often have unrealistic expectations about the extra measures they must take to maintain the new look and lower weight. Although the patients were generally satisfied with the liposuction surgery, 43 percent regained weight. This large percentage seems to have underestimated the importance or ease of making lifestyle changes to prevent weight from returning. Almost all of those *****gained weight did not increase their level of exercise or change their diet after surgery. Obesity surgery refers to techniques used to modify the stomach and or intestines to reduce the amount of food that can be eaten. Select another question for more information. You may qualify for obesity surgery if: You are severely obese (body mass index of 40 or more) or have a BMI of 35 to 39.9 with serious medical conditions such as high blood cholesterol, high blood pressure, sleep apnea and type 2 diabetes. You have tried other methods of weight loss including changes in eating, behavior, increased physical activity and/or drug therapy and are still severely obese. You are unable to physically perform routine daily activities and your quality of life is seriously impaired. You are motivated to making a lifelong behavioral commitment that includes well-balanced eating and physical activity habits which are needed to achieve the best results. There are two types of obesity surgery: restrictive and combined restrictive and malabsorptive: Restrictive surgery uses bands or staples to restrict food intake. The bands or staples are surgically placed near the top of the stomach to section off a small portion that is often called a stomach pouch, which can hold about a half a cup to one cup of food. A small outlet, about the size of a pencil eraser, is left at the bottom of the stomach pouch. Since the outlet is small, food stays in the pouch longer and the patient feels full for a longer time. Combined restrictive and malabsorptive surgery is a combination of restrictive surgery with bypass surgery, in which a surgeon makes a direct connection from the stomach to a lower segment of the small intestine. This limits the amount of food that is digested. Immediately following surgery, most patients lose weight rapidly and continue to do so until 18 to 24 months after the procedure. Although most patients then start to regain some of their lost weight, few regain it all. Surgery improves most obesity-related conditions. For example, in one study blood sugar levels of most obese patients with diabetes returned to normal after surgery. Nearly all patients whose blood sugar levels did not return to normal were older or had had diabetes for a long time. Patients have reported an enhanced quality of life, improved mobility and stamina, better mood, self-esteem and interpersonal effectiveness, and lessened self-consciousness. 10 percent to 20 percent of patients who have weight-loss operations require follow-up operations to correct complications such as abdominal hernias, breakdown of the staple line and stretched stomach outlets. More than one-third of obese patients who have gastric surgery develop gallstones, which are clumps of cholesterol and other matter that form in the gallbladder. During rapid or substantial weight loss a person's risk of developing gallstones is increased. Gallstones can be prevented with supplemental bile salts taken for the first 6 months after surgery. Nearly 30 percent of patients who have weight-loss surgery develop nutritional deficiencies such as anemia, osteoporosis and metabolic bone disease. These deficiencies can be avoided if vitamin and mineral intakes are maintained. Women of childbearing age should avoid pregnancy until their weight becomes stable because rapid weight loss and nutritional deficiencies can harm a developing fetus. Sources: American Obesity Association, National Institute of Diabetes, Digestive and Kidney Diseases Other weight-control surgeries for obese people alter a person's digestive process to cause the body to lose weight over time. One of the surgeries reduces the size of the stomach. Another type, called a gastric bypass operation, forces food to bypass sections of the digestive tract, reducing the amount of calories and nutrients that the body can absorb. Bypass operations tend to produce more weight loss, but they also pose the most side effects, including nutritional deficiencies. Both kinds of surgery, however, are significantly more effective than medications or counseling. Lifestyle changes Yet people may underestimate the permanent changes in eating habits they will need to adopt after either kind of surgery. Because of the changes in the digestive tract, people need to learn to chew their food more thoroughly than before. Liquids need to be consumed separately from solid foods. Although some people adapt to the required lifestyle changes, experts say that many others continue to struggle with emotions related to food after surgery. Counseling to cope with stress and other emotions without turning to food should be a vital part of anyone's plan to make these operations successful. People who are considering surgery to treat obesity also need to think about the likely outcome. A 30 percent weight loss is about typical. Nevertheless, since candidates for these extreme procedures are so obese, the typical person remains overweight. Although people may not reach their ideal weight, these large weight losses can produce tremendous health benefits. However, if a person expects to be thin and envisions automatic life changes, like more friends, a better marriage and professional success, they can become depressed. When people weigh the risks and benefits of surgery for weight reduction, complications should also be considered. Although rare, they can be severe. Severe obesity, however, also has health risks that include heart disease, diabetes, sleep apnea and cancer that can be just as harmful. Perhaps, surgery may be an ideal solution to a severe weight problem, but all the factors need to be weighed before people select this option. Nutrition Notes is provided by the American Institute for Cancer Research in Washington, D.C.© 2005 MSNBC Interactive From Patty: Bottom line is...KNOW what you are getting into and what kind of changes you will have to make. If you have emotional issues attached to your food intake...get them resolved or under control BEFORE getting WLS. EXPECT anything and everything to happen post-op so you won't be disappointed.

I just read your profile and I suggest everyone read it. Very good and informative. I am pre op and need all the info I can get. Thanks for the article and your profile.