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Weight loss surgery: Band versus bypass continued...

Gastric banding is the safer of the two weight loss surgeries. The operation is typically performed as "belly-button surgery," performed through a small opening in the abdomen, a procedure called laparoscopic surgery. Unfortunately, for severely obese patients the results are often disappointing. "After gastric banding, weight loss is typically slow, and many patients end up losing only a relatively small percentage of body weight," explains Livingston. Because the pouch that's formed by inserting the band can expand if people eat too much food, some patients end up regaining the weight they've lost.

Gastric bypass surgery, on the other hand, is more complicated and carries more risks, including infection, blood clots, and leakage where the stomach and intestine are surgically connected. Because the surgery interferes with absorption, especially of calcium and iron, there is also a lifetime risk of anemia and other nutritional deficiencies.

But bypass surgery is far more effective than banding. Studies show that obese patients can expect to lose up to 2/3 of their body weight. Weight loss usually occurs rapidly. And gastric bypass patients are much more likely than those receiving gastric bands to keep the weight off.

Obesity-related medical problems also vanish with surprising speed. "In diabetic patients, signs of diabetes often resolve immediately after surgery," says Livingston. High blood pressure and high cholesterol improve dramatically. Hip and knee pain are dramatically eased as weight is reduced. Sleep apnea, another serious health risk associated with obesity, also resolves as patients lose fat from around their necks, says Livingston.

A 2007 study by physicians at St. Elizabeth Health Center and Northeastern Ohio Universities College of Medicine bears him out. The researchers followed 400 patients who had undergone gastric bypass surgery. High blood pressure, cholesterol, diabetes, sleep apnea, asthma, and reflux disease had improved or completely resolved in 80% to 100% of these patients after an average of a year. Arthritis, back and joint pain, and depression also had improved, although not as dramatically.

Choosing weight loss surgery

An estimated 5% of the adult U.S. population is severely obese, with a BMI over 40. Far more than that are obese or severely overweight and suffer risk factors associated with excess body weight. Many could benefit from bariatric surgery.

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