by Jack F. Rutledge M.D.
It's no secret that a lot of people struggle to maintain a healthy weight.
But while some strain to lose 10, 20, or even 30 pounds, others stare
at a seemingly insurmountable weight-loss goal—perhaps 100 pounds or
For many who are extremely obese—with a body mass index (BMI) of 40 or
more—losing weight through traditional diet and exercise hasn't worked, and
medical treatments have been largely unsuccessful. Click here to determine your BMI. A result
between 25 and 29.9 is considered overweight, 30 or higher is obese, while 40 or
more is extremely obese.
A diligent and comprehensive effort at weight loss is essential for the
health of all people with obesity. Research has clearly shown obesity to
extremely unhealthy and can lead to early death.
Increasingly, extremely obese people are turning to a more promising option:
bariatric surgery. Most patients lose a large amount of weight, and they keep
the weight off. It's a dramatic and wonderful outcome for them.
Although bariatric surgery is a high-risk operation, the benefits of the
surgery appear to outweigh the health risks of being severely obese. Those risks
include high blood pressure, high cholesterol, type 2 diabetes, gallbladder,
liver, and acid reflux diseases, degenerative joint disease, obstructive sleep
apnea, and many others.
A promising option
The ideal candidates for bariatric surgery have:
- a BMI of 40 or more.
- a BMI between 35 and 39.9 plus a serious,
obesity-related health problem
- tried nonsurgical weight-loss methods and are
still severely obese
- the commitment to make needed lifestyle changes following surgery
Feel full sooner
Various operations can help people lose weight, but all involve making the
stomach smaller. That limits the amount of food it can hold and allows a person
to feel full sooner. In some operations, the surgeon also bypasses a portion of
the small intestine, limiting the amount of food the body absorbs.
Types of surgery include:
Adjustable gastric banding. A hollow band is placed around
the stomach near the top, creating a small pouch that holds about 2 ounces of
food at a time.
Roux-en-Y gastric bypass. Named after Swiss surgeon Cesar
Roux, this type of surgery allows food to bypass the lower stomach and much of
the small intestine. The bypass is still the gold standard for weight loss
surgery in the U.S., balancing risk and effectiveness. Recently, research has
shown significant hormonal changes after the procedure that may help explain
patients’ dramatic decrease in appetite after gastric bypass.
Biliopancreatic diversion. This is a more complicated bypass
operation normally used for the most severely obese. It involves removing part
of the stomach and bypassing an even longer section of the small intestine.
Know the pros and cons
In general, risks from any type of weight-loss surgery include complications
such as infection, leaking, bleeding, blood clots, and intestinal blockage.
Gallstones and nutritional deficiencies also are possible, but they can be
prevented with medication and nutritional supplements.
Benefits include rapid weight loss, and the weight is likely to stay off.
Also, people often see improvements in their obesity-related medical conditions,
which could have been life-threatening.
Jack F. Rutledge, M.D., is a surgeon with University
Surgical Associates. He is also an Assistant Professor of Surgery at the UT
College of Medicine Chattanooga. For more information, call Erlanger’s physician
referral line at 423-778-LINK.