DEAR DOCTOR K: I'm obese. I've tried to lose weight, but nothing has worked. Should I consider weight-loss surgery?
DEAR READER: If you are severely obese, your best chance for long-term weight loss and better health may be weight-loss (bariatric) surgery.
You have several options. Some types of bariatric surgery shrink the size of your stomach -- you fill up sooner. Other types of surgery route the food you've eaten away from your small intestine, the place where nutrients (and their calories) are absorbed. Some types of bariatric surgery do both.
Three of the most common kinds of bariatric surgery are gastric bypass, gastric banding, and a newer procedure called sleeve gastrectomy.
-- Gastric bypass drastically shrinks the size of your stomach. After surgery, you feel full after eating very small amounts of food. The surgery also reroutes the passage of food through your body to bypass most of your stomach and upper small intestine. As a result, your body absorbs fewer calories.
Patients tend to lose weight rapidly for up to two years after gastric bypass. Many maintain a significant weight loss for 10 years or more. But gastric bypass has a higher complication rate than other weight-loss surgeries, and the remaining stomach pouch can stretch over time.
-- Gastric banding is often called a "lap-band." During the procedure, a surgeon places an adjustable band around the opening of the stomach. This restricts the amount of food you can eat.
Compared with gastric bypass, patients tend to lose less weight, more slowly. Also, weight loss is more dependent on your making healthy food choices after surgery.
-- Sleeve gastrectomy transforms your stomach into a narrow tube. The shrunken stomach is less likely to stretch out again than after gastric bypass. It also produces less of the hormone that makes you feel hungry (see below). This helps you feel satisfied with less food.