Nourished Living by Dietician Kelly Hamlin MA, RD, CDN

Weight Loss Surgery comes in a few different varieties

I am willing to guess that we all know someone who has had bariatric surgery. Bariatric surgery promotes weight loss by changing the digestive system’s anatomy, limiting the amount of food that can be eaten and digested.

Those with a BMI of 40 or more, or a BMI of 35 to 39.9 and a serious obesity-related health problem, qualify for bariatric surgery.

When people hear the term “bariatric surgery,” I believe most would assume that it’s the “gastric bypass” surgery.

But what they may not realize is there are several different types of bariatric surgeries.

So you have a point of reference, let me give you a quick and dirty explanation of how normal digestion occurs.

Food passes through the stomach and enters the small intestine where most of the nutrients and calories are absorbed.

It then passes into the large intestine (colon), and the remaining waste is eventually excreted.

There are two basic types of weight loss surgery: restrictive surgeries and malabsorptive (poor intestinal absorption of nutrients)/restrictive surgeries.

They assist with weight loss in different ways.

Restrictive surgeries work by physically restricting the size of the stomach and slowing down digestion. A normal stomach can hold about three pints of food.

After surgery, the stomach may at first hold as little as an ounce, although later that could stretch to two or three ounces.

The smaller the stomach, the less you can eat. The less you eat, the more weight you lose.

An example of restrictive surgery would be Gastric Banding, among the least invasive weight loss treatments.

This surgery uses an inflatable band to squeeze the stomach into two sections: a smaller upper pouch and a larger lower section.

The two sections are still connected, but the channel between them is very small.

This slows down the emptying of the upper pouch.

Gastric banding physically restricts the amount of food you can take in at a meal.

Most people can only eat a one-half to 1 cup of food before feeling too full or sick. The food also needs to be soft or well-chewed.

A risk of this procedure is vomiting, which can be a result of eating too much too quickly.

Complications with the band aren’t uncommon. It might slip out of place, or become too loose, or leak.

Sometimes, further surgeries are necessary. As with any surgery, infection is always a risk.

Although unlikely, some complications can be life-threatening.

Another type of restrictive surgery is Sleeve Gastrectomy. This procedure is usually done with a laparoscope and involves the removal of about 75% of the stomach.

What remains of the stomach following the surgery is a narrow tube or sleeve which connects to the intestines.

Sometimes a sleeve gastrectomy is a first step in a sequence of weight loss surgeries.

It can be followed up by gastric bypass or biliopancreatic diversion (keep reading!), if more weight loss is needed.

However, in other cases it might be the only surgery you need.

Typical surgical risks include infection, leaking of the sleeve, and blood clots.

Malabsorptive/restrictive surgeries are more invasive surgeries that work by changing how you take in food.

In addition to restricting the size of the stomach, these surgeries physically remove or bypass parts of your digestive tract, making it harder for your body to absorb calories.

Purely malabsorptive surgeries—also called intestinal bypasses—are no longer done because of the side effects.

Gastric Bypass Surgery (Roux-en-Y Gastric Bypass) is an example of malabsorbtive/restrictive surgery. The most common type of weight loss surgery, it combines both restrictive and malabsorptive approaches.

It can be done as either a minimally invasive or open surgery.

In the procedure, the surgeon divides the stomach into two parts, sealing off the upper section from the lower.

The surgeon then connects the upper stomach directly to the lower section of the small intestine.

Essentially, the surgeon is creating a shortcut for the food, bypassing a section of the stomach and the small intestine.

Skipping these parts of the digestive tract means that fewer calories get absorbed into the body.

By design, surgeries like this impair the body’s ability to absorb food.

While that can cause rapid weight loss, it also puts the patient at risk of serious nutritional deficiencies.

The loss of calcium and iron could lead to osteoporosis and anemia. And the individual needs to be very careful with their diet and take supplements for the rest of their life.

Another risk of gastric bypass is dumping syndrome, in which food is “dumped” from the stomach into the intestines too quickly and before it’s been properly digested.

About 85% of people who get a gastric bypass have some dumping. Symptoms include nausea, bloating, pain, sweating, weakness, and diarrhea.

Dumping is often triggered by sugary or high-carbohydrate foods. Adjusting the diet helps.

However, some experts actually see dumping syndrome as beneficial in that it encourages people to avoid foods that could lead to weight gain.

Continued next week…

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