Anthony L. Komaroff, M.D.
---- — 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.
Sleeve gastrectomy is considered to be less risky than gastric bypass or gastric banding, but the overall weight loss isn't as dramatic.
It's no surprise that surgery which shrinks your stomach works, or that surgery that causes your small intestine to absorb fewer calories works. However, there is a third way that many types of bariatric surgery work -- and that is a surprise.
About 10 years ago it was discovered that the stomach makes a hormone called ghrelin that travels in the blood. When ghrelin reaches the brain, it stimulates your appetite. About three to four hours after our last meal, our stomachs start to make increasing amounts of ghrelin -- and we start getting hungry. The levels of ghrelin in the blood are greatly reduced by most types of bariatric surgery, because a smaller stomach makes less of the hormone.
We have more information on bariatric surgery in our Special Health Report, "Healthy Solutions to Lose Weight and Keep It Off." (Learn more about this report at AskDoctorK.com, or call 877-649-9457 toll-free to order it.)
If you choose to have weight-loss surgery, take advantage of medical, nutritional and counseling services before and after surgery to help your body and mind adjust to your new normal.
Dr.Komaroff is a physician and professor at Harvard Medical School. To send questions, go to AskDoctorK.com, or write: Ask Doctor K, 10 Shattuck St., Second Floor, Boston, MA 02115.
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