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Real risks. continued...

"There are immediate and long term issues following surgery," says C. Daniel Smith, MD, chief of general surgery and director of Emory Bariatrics at Emory University School of Medicine in Atlanta. "The immediate issue is the pain and suffering of surgery and the risk as it is a major surgery and there is a risk of significant complications -- even death," he tells WebMD. It's also expensive and is often not covered by insurance.

"In the long term, the upside is that medical conditions related to weight will subside, but the downside is that the alteration in how you eat is permanent. This is not something to try out for three to six months," Smith stresses.

All candidates have to undergo a fairly extensive pre-operation evaluation including medical clearance for surgery, assessment of psychological appropriateness for weight loss surgery, nutrition counseling and in some institutions, candidates take a test to demonstrate a comprehensive understanding of the lifestyle changes and what they will mean after weight loss surgery.

Not a magic bullet.

Jacqueline Odom, PhD, the psychological director of the Beaumont Weight Control Center in Royal Oak, Mich., evaluates patients that are on the path to weight loss surgery to help make sure they are ready for this step and to handle the life afterward.

"A lot of people want a magic bullet and really don't understand what is involved," she tells WebMD.

The new stomach requires several tiny, nutrient-rich meals a day supplemented with additional vitamins and minerals. Eating too much or indulging in rich, sugary or fried foods can overload the pouch and cause dumping -- a term used to describe the sweats, chills and nausea that result from food filling the pouch and overflowing straight into the small intestine.

The re-feeding process starts with getting in protein because that will repair the cells and help them heal after surgery. "We use liquid protein supplements to start, then pureed foods, then soft foods like scrambled eggs and then eventually graduate to other foods," Odom says.

"It's not glamorous,' she says. "You have to chew your food more thoroughly then you ever did and really emulsify it. You must eat very slowly and in small portions."

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