It is no secret that obesity is a problem for an increasing number of North Americans, a problem that is taking its physical and mental toll. The larger you are, the higher your risk for developing what are called co-morbid conditions: health problems that are directly related to the strain of carrying around so much extra weight. These conditions can include obstructive sleep apnea, Type 2 diabetes, gastric reflux disease, gall-bladder or liver disease, and venous thromboembolic disease, which can result in painful and damaging swelling in the legs.
Aside from the physical toll that obesity takes, there are also the emotional and psychological factors of being morbidly obese that more and more Americans are battling. Being large is a daily struggle in that the world is built for people who are not large. Add onto that the contemptuous undercurrents that exist in a society that glorifies the morbidly underweight, and you have a society that implicitly blames the obese for their condition.
The reality of the condition of being morbidly obese is that there are genetic factors that play into emotional and physiological reasons why people who are morbidly obese cannot lose their weight simply by diet and exercise alone. Gastric bypass surgery is not an option for people who are simply a little overweight and are not taking steps to lose the weight in order to feel better, physically and emotionally. It is a drastic measure often required to save the life of a person who cannot reduce their weight in traditional ways.
In order to qualify for gastric bypass surgery a person must be meet the certain standards, as outlined by a national health organization. In the United States, for example, the standard for consideration is measured by your Body Mass Index (BMI). This is measured by dividing a person’s body weight by the square of the person’s height, and is expressed in units of kilograms per square meter. Those qualifying for gastric bypass surgery must have a BMI of 40 or greater, or 35 or greater if the person suffers from one or more of the co-morbid conditions listed above.
Other factors that may be taken into consideration are: having been obese for at least 5 years, a history of alcohol abuse, psychiatric disorders such as depression, and your age (you must be between 18 and 65).
The Procedure
Normal digestion involves food passing through your stomach (an expandable pouch that is about the size of a Nerf football), into the small intestine, where nutrients and calories are absorbed, and finally through the large intestine where waste materials are extracted for elimination. Gastric bypass surgery involves two steps. The first step is reducing the size of the stomach by creating an egg-sized pouch at the top of the stomach by using staples or a surgical band. A smaller stomach pouch results in a person being able to ingest only small amounts of food at a time. Some stomach stapling surgeries stop here.
In a gastric bypass, however, there is a second step in which the small intestines are rearranged so that the middle part of the small intestine is attached to that smaller stomach pouch. As a result, the food skips the first part of the small intestine (duodenum), cutting down the number of calories (and nutrients) that are absorbed into the system.
There are several techniques, but the one described above (called the Roux-en-Y method) is the most common. First performed in 1993, this technique consists of making a large incision in the abdomen. A newer technique uses laparoscopic technology, which involves a smaller incision and the use of smaller instruments and a camera to perform the surgery. While the laparoscopic technique is more difficult to perform, it can reduce the potential for bowel obstruction and infection that a larger incision in the abdomen carries.
Be very careful in choosing a doctor and facility for your gastric bypass surgery. Your best bet is to choose a medical facility that has a department devoted to Weight Loss Surgery, as they will be best equipped to handle your aftercare. The learning curve for performing these surgeries is about 100 surgeries, so the more experienced your doctor is, the lower your chances are of experiencing complications, and the better equipped your doctor will be in identifying and treating possible complications early.
The Aftermath
If you go the open surgery route, expect to be in the hospital 4 to 6 days, for the laparoscopic procedure, 2 to 3. After a successful surgery, weight will begin to come off over a period of 10 to 54 months, but the road to recovery can be difficult for several reasons.
Possible complications can include those that are common for any abdominal surgery: infection in the incision, bowel obstruction caused by scar tissue from the incision, hemorrhage in the blood vessels cut to divide the stomach, hernia, ulcers and blood clots forming in the arteries of the pelvis or legs.
Complications specific to gastric bypass include leakage in the new connection between the stomach and small intestine (anastamotic leakage), contracting of the opening between the stomach and lower intestine due to scar tissue (anastamotic stricture), gall stones, and dumping syndrome, caused by sugary foods passing too quickly into the bowel. Dumping syndrome can cause dizziness, nausea, and diarrhea. The symptoms can persist for 30-45 minutes, but can be prevented by avoiding the sugary foods that are not recommended for post-gastric bypass surgery regardless.
Nutritional deficiencies affect up to 30% of gastric bypass patients as well, due to the bypass of part of the small intestine that is important for nutrient absorption. You will be required to meet with a dietician to help avoid any deficiencies. The most common deficiencies include calcium (which can lead to hyperparathyroidism and osteoperiosis), iron (which can lead to anemia), vitamin B12, and protein, leading to the rapid deterioration of muscle mass.
Ten to twenty per cent of patients will have to go back into surgery at least once to deal with complications. Of course, as with any major surgery, death can occur; in the case of gastric bypass surgery, the mortality rate is about .5%.
Apart from physical side effects, you will have to deal with drastic lifestyle changes and the emotional effects that will ensue. It is important that you have emotional support after the surgery, as eating as a reaction to emotional issues will no longer be an option. Eating will be reduced to providing fuel to keep your body in motion, not as a means of emotional comfort. This might be difficult in dealing with the emotional upheaval of changing your lifestyle, but it may also bring to the fore emotional issues that you have been masking with unhealthy eating practices. Emotional issues that you had before are not going to go away with gastric bypass surgery.
Also, you must be ready to face the fact that drastic weight loss, even coupled with regular exercise, is going to leave your body with a lot of excess skin. You will likely have excess skin hanging over your knees, on your abdomen, on your buttocks, and on your arms. There is plastic surgery that can help you get rid of the excess skin, but with any surgery comes the risk of further side effects, not to mention the added cost and recovery time. While some insurance plans will help you cover the approximately $15,000 the gastric bypass costs, it will not cover cosmetic surgery to remove excess skin after the weight is gone.
In the end, the good news will be that with a successful procedure, you will likely lose 65 to 85% of excess body weight (which is defined as weight that exceeds the ideal body weight for your height and frame). Emotional benefits aside, there will be significant health benefits, which should be the primary motivation for the surgery at the outset. A dramatic reduction in hypertension and hypercholesterolemia will likely follow. Sleep apnea is markedly improved, and in up to 90% of cases, Type 2 diabetes is reversed. Add onto this the reduction of typical back and joint pain, as well as mobility problems, that accompany morbid obesity, and your daily quality of life will increase tenfold.
With a motivation to get healthy and stay healthy, gastric bypass surgery can be a lifesaver for the morbidly obese. With the proper emotional supports, it can mean a lease on life, both physically and emotionally.