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Bariatric Surgery

A Radical Obesity Fix

WebMD Feature

Dec. 18, 2000 -- Two years ago, Rhonda Bailey was fat and miserable. The 38-year-old bore 245 pounds on her 5-foot-1 frame. Squeezing into a restaurant booth, airplane seat, or amusement park ride was unimaginable. Walking made her joints stiff and sore. She leaned heavily on a cane to get from the handicapped parking space to her desk at work.

Today, Bailey is literally half the woman she used to be. Over the past 18 months, she has shed 50% of her body weight. Her waist shrunk from a size 26 to a size six. Now, at 125 pounds, the Southern California resident jogs daily, bicycles with her stepdaughter, and rejoices in her ability to do life's little things -- like tying her shoes -- without asking her husband for help.

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Bailey's secret isn't the latest fad diet or radical weight loss drug. She owes her slimmed-down body to gastric-bypass surgery. The procedure is just one of several weight loss operations that fall under the heading of bariatric surgery.

As obesity rates creep skyward, so do the number of Americans turning to surgery as a weight loss tool. Although today's bariatric surgery is safer and more effective than earlier versions, the procedure is not an instant cure. Reserved only for the severely obese (those who tip the scales at 100 pounds or more over their normal body weight), bariatric surgery is a drastic step with a high rate of complications. Patients must make radical, lifelong dietary changes, and permanent weight loss is not guaranteed. Still, a growing number of doctors are recommending bariatric surgery for severely obese patients who find themselves at wits' end about weight loss.

The increasing demand for bariatric surgery reflects the country's obesity epidemic. In the United States, 55% of adults are overweight. Four million Americans are severely obese. Of that group, 80% are women of childbearing age.

The average bariatric surgery patient is a woman in her late 30s who weighs approximately 300 pounds, says Robert Brolin, MD, president of the American Society for Bariatric Surgery. Brolin estimates the number of bariatric surgeries performed this year will reach 40,000 -- double that of five years ago. He attributes the procedure's popularity to the rise in obesity rates and the willingness of insurance companies to cover the operation's $25,000 and up price tag.

How It Works

During bariatric surgery, the stomach is closed off, leaving only a small pouch about the size of a thumb for food. As a result, patients feel full on fewer calories. However, the most common procedure -- gastric-bypass surgery -- goes one step further. Surgeons not only shrink the stomach but also reroute the small intestine to thwart the digestive process, thereby decreasing the number of calories absorbed.

This is achieved by making a direct connection between the stomach and a lower section of the small intestine. The first segment, the duodenum, is skipped entirely. The duodenum's chief responsibility is igniting the digestive process and absorbing iron and calcium from food. So in the end, patients eat less and absorb fewer calories. Sound too good to be true? Consider the price.

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