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Weight Loss Surgery: What Are The Options?

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 the 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 the 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 afterward. From this observation, grew the trial use of stapling across the top of the stomach, reducing 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 restructuring, 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 jejunoileal bypass reduced the lower digestive tract to a mere 18” of the 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 carbohydrates, 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 the 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 for keeping cholesterol in solution is reduced by malabsorption and loss through stool. As a consequence, cholesterol concentration in the gallbladder 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 a 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 milkshakes, 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.

 

Weight Loss Survey: Why Dieters Fail To Lose Weight

Current levels of overweight and obesity, together with weight-related diseases, have made weight control a major health priority throughout America. Yet statistics indicate that average weight reduction on conventional diets adds up to a mere 5-8 pounds per year. So why do we find dieting so difficult? According to a new survey(1), the answer seems to be: that we make 3 crucial mistakes. We don’t have a good enough incentive; we allow ourselves to go hungry, and we can’t cope with “bad days”.

The weight loss survey conducted by The University of Michigan’s Susie Collins asked dieters to select the three biggest problems they faced when dieting. The most common problems reported were: “Inadequate incentive to lose weight” (76%); “Hunger” (72%); and “Bad days” (70%). Although these results will come as no surprise to most dieters, they highlight the importance of motivation in the dieting process. We examine how these problems occur, and what steps can be taken to overcome them.

 

Why Do We Need an Incentive?

We gain weight because we take in more energy than we use. Either because we eat too many calories, or burn to few, or both. So if we want to reduce weight, we need to improve our eating and exercise habits. And this is not easy, because let’s face it – old habits are not easily discarded, especially if they involve cutting out our favorite treats. We need a powerful incentive to help us change. Specifically, we need an answer to the question: “How exactly will I benefit from losing weight?”

When faced with this question, many dieters have no answer. Those who do, typically reply: “I’ll feel better” or “my health will improve”. Others explain they are trying to lose weight to please their doctor or their partner, or simply because they are “overweight”. Unfortunately, none of these reasons are strong enough to help us succeed. So when temptation strikes, we are unable to resist.

 

What Type of Incentive is Best?

Our motivation to lose weight must be based on a selfish, specific benefit. A good example might be an upcoming beach holiday, a family occasion, or the achievement of a specific mobility or fitness goal. It must be as specific as possible (general benefits are useless) and ideally related to a fixed date. In addition, it must be selfish.  Losing weight to please others rarely works. The advice I give to my clients is very simple. Do not bother dieting unless you have a good incentive. Because no matter how good the diet, no matter how valuable the exercise plan, unless you have a powerful reason to change your habits you won’t succeed.

 

Hunger Kills Diets

Most dieters are still convinced that calories are their enemy. So the less they eat, the faster they are likely to lose weight. This is not true. In reality, the less we eat, the more hungry we get, and the easier it is to fall into temptation. The human body is trained to eat when hungry and no amount of willpower will neutralize this basic urge. This is why binge eating is such a common response to low-calorie diets.

 

How to Avoid Hunger

No rocket science here. Avoiding hunger simply means eating regularly throughout the day, and keeping your calorie intake above 1000-1200 per day. This prevents hunger, thus reducing the urge to overeat, and in addition, helps to maintain a regularly high level of calorie-burning.

 

Eat Too Much Rather Than Too Little

We all have days when we feel extra hungry, even when we are dieting. This is no problem – simply eat more! It is always better to eat a little too much than not enough. Might this delay your weight loss? Yes. But so what? Taking a few extra days to achieve your goal is not a problem. The real danger is not eating enough and ending up hungry and depressed. This is a recipe for a binge.

 

Bad Days and The Problem of Perfection

No dieter is perfect. The truth is, all dieters experience “bad days” or fall into occasional temptation. Sadly, most dieters insist on “being perfect”. They cannot tolerate these lapses. So if (say) they visit a friend and end up eating 2 containers of ice cream and a box of cookies, they go to pieces. “I’m useless!” they cry. “I’m a failure!” Overwhelmed by guilt at not being perfect, they then quit their diet in disgust.

 

It’s the Guilt That Does the Damage

In this situation, the actual binge is typically fairly harmless. I mean, we need to eat a huge quantity of food (3500+ calories) to gain even one pound of weight. The real damage is caused by the ensuing guilt. And this is what we need to address.

 

Guilt Comes From Trying to Be Perfect

All dieters make mistakes and this is perfectly normal. Having an occasional binge is no cause for alarm, far less guilt. Even my most successful clients – those who have lost 100+ pounds – had regular lapses. The difference is, that they didn’t see themselves as “perfect” individuals. So they felt “entitled” to make occasional mistakes, and so should you. Once you accept this, you will find dieting a whole lot easier.

 

We Need Support to Make These Changes

In order to overcome the 3 problems described above, an essential first step is to find proper support. This is just as important as choosing the right diet plan, because no matter how good the diet, it can’t motivate you to stay on track – only people can do this. Dieting is ten times easier when you receive encouragement from others. So when choosing an online weight loss program, choose one with an active forum. Because at the end of the day, it’s all about people. When we are alone and isolated, the smallest obstacle can seem like a mountain. But when we have people behind us, anything is possible.

 

Notes:

Weight Loss Survey – A total of 17,403 subjects replied to the survey. They were asked to choose 3 from a list of 10 diet problems. The results were as follows:

(1) Inadequate Incentive (76%).

(2) Hunger (72%).

(3) Bad Days (70%).

(4) Boredom (69%).

(5) Stress (60%).

(6) Interference From Others (51%).

(7) Too Much Eating Out (32%).

(8) Eating on The Run (28%).

(9) Ill-health (5%).

(10) Lack of Sleep (1%)

Originally posted 2020-08-15 07:05:48.

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