Types of Weight Loss Surgery
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. If you study any group of patients who have had weight loss surgery, you will see a wide range of success: superstars, saboteurs, and everything in between. Some patients will lose lots of weight in the first year and others will lose very little.Weight loss operations fit into two categories: restrictive and malabsorptive. Restrictive operations, such as the adjustable gastric band, 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 adjustable gastric band and the vertical banded gastroplasty (VBG). The VBG has fallen out of favor because it tends to fail after a few years when the small gastric pouch tends to stretch out over time and the weight returns.
Weight loss following the laparoscopic adjustable gastric band procedure is safer and more natural. On average, gastric band patients may lose weight more slowly than gastric bypass patients in the first year, preventing muscle wasting from protein malabsorption but their long-term results are the same. The main determinant of success is how well you are using your tool. We have many gastric 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 causes significant malabsorption and is a radical procedure, typically reserved for patients who fail other surgical efforts at weight loss.
The gastric bypass is a very popular operation that has been around a long time, but has a relatively high death and complication rate.
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.
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 type of weight loss 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 that doesn’t tell the whole story. On average, band and bypass patients lose 65 percent of their excess weight at two years. Bypass patients tend to lose pounds quickly in the first year due to protein malabsorption and muscle wasting, which is a very unhealthy way to lose weight. After a year, many bypass patients can regain some or all of their lost weight because the pouch stretches out leading again to overeating. We do not know how common this is because bypass surgeons do not report the incidence of weight regain in long-term studies.
Adjustable gastric band patients tend to lose pounds more slowly during the first year because it is a healthier more natural weight loss. Gastric band patients burn fat, not muscle. Since the adjustable gastric band is easy to adjust for the rest of your life, you do not often see band patients regaining all of their weight over time. The only long-term studies of band and bypass patients show excess weight loss of 53 percent in both band and bypass patients. It is true that you can lose just as much weight with a band as you can with a bypass. And averages do not tell the whole story. We have many band patients that lost weight faster than gastric bypass patients because they are using their tool to its maximum effectiveness, which is a better determinant of success than which operation you choose.
It should not matter how much weight you lose in the first year. You should focus more on how much weight you lose over time. The whole purpose of weight loss surgery is to help you lose lots of weight and keep it off long-term. The band accomplishes this without the high death and complication rate of gastric bypass. Many gastric bypass patients also regain a large portion of their weight. The latest solution to resolve this situation is to place an adjustable gastric band around the stretched out pouch. Patients lose weight after this, but they still suffer from malabsorption. It doesn’t make sense to have a high-risk operation with radical weight loss from malabsorptive muscle wasting only to regain the weight when the pouch stretches out. Why wouldn’t you simply have a band in the first place?
The adjustability of the band is a key feature. The band adjusts easily to suit your needs for the rest of your life. The bypass is a “one-size-fits-all” approach. If the size of the pouch or the restriction is not perfect, then the patient must adapt to the pouch. Adjusting a band simply involves an office visit to access the adjusting port in the office. Adjusting the band does not require more surgery.
How weight loss surgeries work
The gastric bypass has a restrictive component and a malabsorptive component. The restrictive component comes from cutting and stapling the stomach into a small pouch. Many bariatric surgeons believe that the restrictive component is the main part of the gastric bypass that causes weight loss. They believe that you do not need malabsorption to lose weight. The gastric band gives you this restriction without all the risks and complications of malabsorption.
Vitamin Absorption
If you deprive the human body of important nutrients, it will get them wherever it can. If you do not absorb enough protein, the body breaks down your muscle. If you do not absorb enough calcium, your body breaks down the bones. One of the many advantages of the gastric band is that digestion and absorption are normal. Gastric bypass surgery decreases the absorption of protein and vitamins. Protein malabsorption causes muscle wasting. Calcium malabsorption causes severe osteoporosis. Thiamin deficiency can cause irreversible nerve damage. If gastric bypass patients take all the required vitamins, they are OK. But humans do not like taking pills. This is why pharmaceutical companies create once-a-day formulations. If you have to take more than one pill per day, compliance decreases. Since gastric bypass patients have to take so many vitamin pills, they tend to take them for one year, but then stop. This is when you start to see severe vitamin deficiencies and severe osteoporosis from calcium malabsorption. One study showed that 40 percent of women develop severe osteoporosis after gastric bypass because they stopped taking their vitamins. Some gastric bypass patients develop vitamin deficiencies despite taking their vitamins because the vitamins are not being absorbed properly. Some gastric bypass patients require intramuscular injections of vitamins to maintain normal levels.
Gastric bypass creates a chronic disease and you have to take many vitamin pills every day for the rest of your life. This defies the main purpose of weight loss surgery, which is to get healthy, reduce medications and become a thinner, healthier person.
Why do so many obese Americans choose gastric bypass over gastic band?
Unfortunately, most people have no idea that the gastric band option exists. As more people find out about it, the number of band operations performed in the U.S. will continue to rise. In addition, there are many misconceptions about the band. Many gastric bypass surgeons are not comfortable performing laparoscopic surgery, so they simply tell patients that it doesn’t work. The band has been available in Europe since 1993 and has overtaken gastric bypass as the number one weight loss operation, and, eventually, this will happen in the U.S. It does not help that health insurance companies are slow to cover newer technologies. Most health insurance companies are not looking to increase the number of procedures they cover. Some insurance companies will cover a gastric bypass, but deny coverage for the band. In essence, the health insurance company is forcing patients to have a much riskier operation.