Keep in mind that one option is to have no treatment. However, zero treatment tends to have zero results. Another option is to try medical or “non-surgical” treatment such as dieting and exercise. Once you are more than one hundred pounds overweight, however, the long-term success of medical treatment alone is dismal. Most patients regain the weight long-term. While dieting, most patients suffer from depression, anxiety, irritability, weakness and preoccupation with food. Many patients will repeatedly lose and regain weight (“yo-yo” dieting), which is actually harmful. Another option is surgery. Keep in mind that all patients should attempt non-surgical weight loss efforts first, because a small percentage of patients will have long-term success.
In 1991, the National Institutes of Health determined that weight loss surgery is a reliable method proven to achieve significant, long-lasting weight loss in patients with morbid obesity. Weight loss surgery is simply a tool for weight loss. Patients that get their bands adjusted and attend support group will reach their goal weight over time.
Weight loss operations fit into two categories: restrictive and malabsorptive. Restrictive operations turn the stomach into a small pouch, making you feel full and not hungry all the time. Malabsorptive operations bypass a portion of the small intestine, which reduces the efficiency of digestion and absorption of food, protein and vitamins. Examples of purely restrictive operations include the LAP-BAND, REALIZE band and the vertical banded gastroplasty (VBG). The VBG has fallen out of favor because it tends to fail after a few years. The small gastric pouch tends to stretch out over time and the weight returns.
Weight loss following Laparoscopic Adjustable Gastric Band (LAP-BAND, REALIZE band) is safer and more natural. On average, band patients may lose weight more slowly than gastric bypass patients in the first year, but band patients do not have muscle wasting from protein malabsorption and their long-term results are the same. The main determinant of success is how well you are using your tool. We have many band patients who lose more weight than gastric bypass patients because they are using their tool effectively.
Examples of malabsorptive operations include the gastric bypass and the biliopancreatic diversion with or without duodenal switch (BPD/DS). The BPD/DS is a radical procedure with significant malabsorption. These procedures have been around a long time, but are falling out of favor due to relatively high death and complication rates.
Although it is true that weight loss surgery is less risky than remaining obese, it is important to understand that these operations are not without risks. As a rule, all operations have the potential for complications, and these operations are no exception. There is no such thing as zero-risk surgery. However, surgeons use modern surgical science and experience to minimize risk as much as humanly possible. You should carefully review the various weight loss operations and the risks and complications associated with each of them. Surgery is not an easy way to lose weight, but it is the only way for most obese persons to lose weight and keep it off long-term. If you are prepared to make fundamental changes in your approach to food and life, then weight loss surgery might be the right solution for you.
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Average results
To some degree, looking at average results is not very helpful, because weight loss surgery simply gives you a tool to help you lose weight. For each surgery, there are superstar patients that use their tool really well and lose lots of weight and there are patients who sabotage the operation. If you average the superstars and sabotagers together, you get an average result.
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