Bariatric Surgery – Weight Control and Obesity

Much emphasis is placed on obesity and the effects on health as well as eating healthy. There are those who do decide to change their lifestyles either by traditional methods such as diet and exercise or by gastric by-pass surgery. Surgery appears to be the easiest route to take and the quick cure for some of the ailments that coincide with obesity. Is this surgery a long term solution for those who have had a lifelong relationship with food?
What is Bariatric Surgery
Gastric bypass surgery according to MedlinePlus is a surgery that is performed on severely obese individuals in order to help them lose rapid weight due to risk factors that the additional weight is causing or may cause in the future. The process includes two steps with the first being using staples to divide the stomach into two sections. The now smaller section of the stomach will hold approximately an ounce of food at a time which allows the individual to feel full on a very small amount of nutrient. The second step of the surgery includes taking the larger part of the stomach and routing it down to the end of the small intestine so that the food that is digested, it “bypasses the lower part of the stomach which means the food has a less distance to travel allowing the body to retain fewer calories” ( Gastric bypass surgery, 2010). The first gastric bypass surgery was developed by Dr. Edward Mason in 1967. Dr. Mason found that “females who had undergone partial gastrectomy for peptic ulcer disease, tended to remain underweight following the surgery, and that it was very difficult to achieve weight gain in this patient group” and applied a similar surgical procedure on overweight females in the hopes the same results would be achieved (Macgregor, 2002).

Statistical Information
The average age for those receiving gastric bypass surgery is forty-four years old however, obese teens as young as thirteen are obtaining the surgery . The typical candidate for bariatric surgery is someone who is 100 pounds overweight or has a Body Mass Index of 40%. The surgery is typically used first and foremost for people who have tried traditional methods to lose weight but were unable to keep it off or were unsuccessful at losing enough for them to be considered healthy. Many times, those opting for surgery do so because the weight is causing health issues which could lead to an early death. Some of the health effects of being severely overweight include “type 2 diabetes, coronary heart disease, or severe sleep apnea” (Bariatric surgery for severe obese, 2009).

Psychology and Obesity
Due to the fact that sometimes obesity can stem from eating disorders and an addiction to food and sometimes even drug or alcohol addictions it is recommended that prior to surgery, patients should undergo a psychiatric evaluation. Depression also seems to be dilemma for those who are obese and the mere act of surgery does not mean an automatic cure for these issues. According to the American Journal of Psychology, “all major insurers in the United States currentlyrequire a comprehensive pre-surgical psychological/psychiatricevaluation as part of a mandatory workup before approving surgery”. These evaluations before surgery can give a good indication if the person will be able to comply with all the changes that are necessary after surgery. If it is found that a patient will not be a good candidate for surgery based on the post surgical risks of their behaviors then the surgery is usually denied or postponed until a later time ( Marcus & Kalarchian, 2009).

Diet after Surgery
After the gastric by-pass surgery the patient has to follow a strict regime of foods for the first few months in order to allow for healing time of the stomach. According to the Mayo Foundation for Medical Research, a few days after surgery the only foods allowed are liquids such as “broth, unsweetened juice, milk, strained cream soup and sugar free gelatin” which can be ingested a few ounces per meal. This stage of the diet will continue until the patient is able to tolerate them which usually lasts a few days. The next foods incorporated for the next few weeks all have to be puréed and can include “lean meat, beans, fish and egg whites and can be mixed with milk, low fat gravy, water and sugar free juice”. As the digestive system is able to tolerate the foods eaten, soft foods and then eventually solids are incorporated but it is a slow process. In order to ensure nutrients are maintained at a healthy level, the patient will be required to take a multi-vitamin for the rest of their lives (Gastric bypass surgery. 2009).

Rapid Weightloss
According to the University of California San Diego Center for the Treatment of Obesity, rapid weight loss can begin immediately after surgery and for the first year can average a loss of about five to ten pounds a month and then begins to slow down after about 12 to 18 months, for some the weight loss can be as much as 80% of their excess weight. In order to continue weight loss and maintenance after the surgery, an exercise routine should begin after about a week and should start with walking. After a couple of weeks aerobic activity should be added and then after six weeks weight training may begin (Results, 2009).

Temporary Mental Improvement
Drs. Greenberg, Smith and Rockart reported that in a study of 157 patients conducted by Waters et al. that it appears that for the first year after surgery many of the patients have an improved positive mental outlook on life because many of them have lived with obesity and the embarrassment that can come along with that for years. During the first year after surgery, the patient is able to watch the weight appear to melt off their bodies which is also accompanied by much praise from those around them. Another factor is that they are able to travel longer distances without having the sometimes unbearable pain in their joints and many of them had been sedentary for years and they now have a new freedom of being able to leave the home without embarrassment and walk if they wish. After the first couple of years when the excitement of their new life has faded is when some old, harmful habits may return. It appeared that binge eating ceased for a couple of years after surgery and then in some returned. Suicide was also determined to be higher in postoperative weight loss patients compared to the general population ( Greenberg Et Al., 2004) .

Addiction Transfer and Carnie Wilson
Addiction transfer can many times become an issue with those who had previously suffered from emotional eating prior to surgery. The article also went on to explain how Carnie Wilson, once known as the Lead Singer in Wilson Phillips suffered from addiction transfer after her surgery and instead of turning to food as she did in the past she used alcohol to fill the void . While the final verdict is still being determined, experts estimate that anywhere between 5% and 30% of post surgery patients suffer from addiction transfer and is not just limited to alcohol abuse but can also include “recreational drug use, compulsive shopping, excessive gambling, and indiscriminate sex” according to Melodie Moorehead, a weight loss therapist . One of the techniques to curb this occurrence happening after weight loss surgery is to ensure patients get adequate pre surgical therapy to address the issues that emotional eating patterns may be linked to. Post surgery, continuing the therapy is recommended to ensure the patients are well informed of the signals that could lead them back into the same negative patterns. Group therapy such as ” Overeaters Anonymous (O.A.), Food Addicts Anonymous (F.A.A.), Food Addicts in Recovery Anonymous (F.A.) and Alcoholics Anonymous (A.A.)” is also recommended as a support system for those who have addiction transfer ( Limit Addiction Transfer After Bariatric Surgery, 2009).

Regaining the Weight
There have been some patients who have regained a lot of the weight they have lost because they did not maintain the proper diet and exercise regime and returned to the old eating habits over time. The high calorie foods, which should be avoided continue to be an emotional high as well as the lack of exercise to help burn the excess calories. The small pouch that was initially created during surgery can be stretched in order to hold more food which is what aids in regaining the weight.

Therapy Must Continue for Success
Weight loss surgery can be an easy fix, the same results may be obtained without surgery if one has enough will power to do this on their own with the proper guidance of a medical team monitoring what they eat and how much they exercise and also with a good therapist working on the root of what causes them to eat based on emotions. Granted, not everyone who is overweight has an eating disorder but the ones who do have a disorder with food cannot be cured by simply having surgery, the same eating patterns can continue even after surgery.

Sources:
Bariatric surgery for severe obese. (2009). Retrieved August 12, 2010 from U.S. Department of Health and Human Services,
Weight Control Infomation Network: http://win.niddk.nih.gov/publications/gastric.htm

Case control study of successful maintenance of a substantial weight loss: individuals who lost weight through surgery versus those who lost weight through non-surgical means. (2000). International Journal of Obesity, 24, 573-579

Gastric bypass surgery. (2009). Retrieved August 14, 2010 from Mayo Foundation for Medical Research, MayoClinic.com: http://www.mayoclinic.com/health/gastric-bypass-diet/my00827

Gastric bypass surgery. (2010). Retrieved August 10, 2010 from MedlinePlus: http://www.nlm.nih.gov/medlineplus/ency/article/007199.htm

Greenberg, I., Ph.D., Smith, K., Psy.D, & Rockart, E., Ph.D. (2004). Behavioral Health Evaluations in Bariatric Surgery. Nutr Clin Care, 7, 5-11

Limit Addiction Transfer After Bariatric Surgery. (2009). Retrieved August 14, 2010 from Obesityaid.org: http://www.obesityaid.org/surgical-weight-loss/limit-addiction-transfer-after-bariatric-surgery/

Macgregor, A. (2002). The Mason Era. Retrieved August 10, 2010 from The Story of Surgery for Obesity: http://www.asbs.org/html/story/chapter4.html

Marcus, M. D., Ph.D, & Kalarchian, M. A., Ph.D. (2009). Psychiatric Evaluation and Follow-Up of Bariatric Surgery Patients. American Journal of Psychiatry, 166, 258-291

Rationale for the Surgical Treatment of Morbid Obesity. (2005). Retrieved August 12, 2010 from American Society for Metabolic and Bariatric Surgery , Rationale for Surgery: http://www.asbs.org/newsite07/patients/resources/asbs_rationale.htm

Results . (2007). Retrieved August 14, 2010 from University of California San Diego, Center for the Treatment of Obesity: http://health.ucsd.edu/specialties/lapband/about/results.htm

Weight-loss maintenance in successful weight losers: surgical vs non-surgical methods. (2009). International Journal of Obesity, 33, 173-180