Obesity Surgery Permanent Weight Loss

By Joseph Afram, MD

Weight loss (bariatric) surgery is a unique field, in that, with one operation a person can be potentially cured of numerous medical diseases including diabetes, hypertension, high cholesterol, sleep apnea, chronic headaches, venous stasis disease, urinary incontinence, liver disease, and arthritis.
Bariatric surgery is the only proven method that results in durable weight loss. This proven surgical approach, combined with the dismal failure of dieting, the marked improvement in quality of life and the quick recovery with minimally invasive techniques, has fueled the surge in the number of bariatric procedures performed annually over the last 10 years.
There are various forms of bariatric surgery, with the gastric bypass being the most frequently performed. Drs. Mason and Ito initially developed the gastric bypass procedure in the 1960s. The gastric bypass was based on the weight loss observed among patients undergoing partial stomach removal for ulcers.
Over several decades, the gastric bypass has been modified into its current form, the Roux-en-Y gastric bypass (RYGBP). The RYGBP is the most commonly performed operation for weight loss in the United States. In the U.S. approximately 140,000 gastric bypass procedures were performed in 2005.
The RYGBP has been proven in numerous studies to result in durable weight loss and improvement in weight-related medical illnesses. Half of the weight loss often occurs during the first six months after surgery; weight loss usually peaks at 18-24 months.
The obesity-related comorbidities that may be improved or cured with the RYGBP include diabetes mellitus of the adult onset type (so-called insulin resistant), hypertension, high cholesterol, arthritis, venous stasis disease, bladder incontinence, liver disease, certain types of headaches, heartburn, sleep apnea and many other disorders. Furthermore, the RYGBP has resulted in marked improvements in quality of life.
The mechanism in which the RYGBP works is complex. After surgery, patients often experience marked changes in their behavior. Most patients have a reduction in hunger and feel full sooner after eating. Patients often state that they enjoy healthy foods and lose many of their improper food cravings. Rarely do people feel deprived of food. These complex behavioral changes are partially due to alterations in several hormones and neural signals produced in the GI tract that communicate with the hunger centers in the brain.
Another mechanism for weight loss after the RYGBP is referred to as the dumping syndrome. Dumping may result in lightheadedness, flushing, heart palpitations, diarrhea and other symptoms early (within 10-30 minutes) after eating sweets or foods with a high concentration of sugar. Some people remain extremely sensitive to sweets for the rest of their lives; most patients lose some or all of their sweets sensitivity over time.