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Weight Loss Surgery for Obesity

Bariatric surgery as a quick fix for obesity in men

Weight loss surgery: Band versus bypass

The simplest type of weight loss surgery, gastric banding, involves placing a band around the upper part of the stomach, which creates a small pouch. The operation restricts the amount of food that can be digested, making people feel full with much smaller portions.

In the second and more complicated procedure, gastric bypass surgery, the surgeon creates a small pouch out of the stomach and directly connects the pouch to the large intestine. In most cases part of the large intestine is also removed. Because a large stretch of the digestive tract that normally absorbs food is bypassed, patients absorb fewer calories from the food they eat.

For men, weighing the risks and benefits of these two types of weight loss surgery is especially thorny. "Men in general experience more complications from bariatric surgery than women," Livingston explains, "probably in part because they carry more abdominal fat than women, so the operation is more difficult to perform. "But men also suffer more complications as a result of obesity than women, so they stand to benefit more by losing weight."

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.

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