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Weight loss surgery: Drastic solutions to a drastic problem continued...

Since surgical approaches to treat obesity were first undertaken in the 1970s, they've been controversial. If the problem is that obese people eat too much, chopping away parts of their stomachs and intestines to get them to eat less seems an extreme solution.

"But the fact is, dieting and other lifestyle interventions simply don't work very well for most people," says Edward Livingston, MD, a surgeon at Southwestern Medical School in Dallas and head of bariatric surgery for the nation's Veterans Affairs system. "And for people who are obese, they almost always fail." To keep prescribing treatments that have been shown repeatedly to fail is simply bad medicine, he insists.

In truth, early attempts at weight loss surgery didn't work all that well either. They carried serious risks of infection and death. But now, surgeons have refined two basic approaches, experts say, gastric banding and gastric bypass surgery, which offer better results with far fewer complications than earlier procedures.

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."

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