Reviewed by Melinda Ratini on May 27, 2016
Ken Fujioka, MD Director, Nutrition and Metabolic Research Center, Scripps Clinic
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Kenneth Fojioka, MD: The good news is there’s not just one surgery that fits all, but rather, there’s three different surgeries, each of which has its place for weight loss, and there may even be a fourth that might be coming out. So there’s several surgeries that are available right now. In essence, there’s a standard gastric bypass. This is the most aggressive out of all of them, but it actually for someone who has over 100 pounds to lose, they need to really start thinking about this surgery, particularly if they have type 2 diabetes. Because we know they’re going to do much, much better. And what you do is you bypass the first part of the intestines or the stomach and bring food into the lower part of the intestines. What that does is, it changes the hormones that tells you you’re full and gets the body to lose weight. There’s another newer one, though, that’s a little bit less aggressive, which has fairly good weight loss, which is called the sleeve gastrectomy. So you don’t really change the plumbing or the direction of food or anything like that, but rather, you just make the stomach smaller. It does two things: One, you can’t eat as much. But two, one of the hormones that we know drives you to eat is from the stomach. You change that hormone and lower it. So you don’t want to eat as much. So it actually has a hormonal effect, hence, good weight loss. The last one is the gastric band, where you actually put a band on the stomach. It’s a device. Admittedly, we don’t use near as much as we used to because it doesn’t give as good a weight loss, because it doesn’t adjust any of those hormones, but again, will get the patient to eat less. So depending on the needs, there’s multiple choices in bariatric surgery that for the patient who is what we consider seriously obese, they are options that really should be thought about.