Gastric Bypass

I am a 23 year old, obese woman. I have tried every diet and none have come through. I eat a low fat diet and workout 1 to 2 hours a day. Nothing has worked. I am thinking about having a gastric bypass. I have talked to two women, one of which I know well, who have had it done and say it was the only cure for their obesity. They have lost the weight and neither have had any complications. My doctor was not well informed about the operation, but with what she had heard about it she doesn't think I should do it. She has patients that live with pain as a result of the bypass but has not seen the successes. Can you offer any info about this? I feel like it may be my only hope.

Because obesity often has multiple causes, it is rarely "cured" through one method of treatment. The development of obesity is a complex interaction between genetic, behavioral and environmental factors, making some individuals more susceptible to obesity than others. Changing one's lifestyle, to include lower calorie intake and more exercise, is an essential and important first step. It is also a step that will have to be continued in combination with any other treatment, including surgery. It is equally important that any woman who is suffering from obesity have her doctor or health care provider assess the extent to which she is overweight. Together, they can figure out what is contributing to the obesity: genetics, nutrition, lack of exercise. Evaluating the causes of a woman's obesity is significant to choosing an appropriate course of treatment.

The goal of any course of treatment should be focused on weight management rather than simply weight loss. Weight management must concentrate on attainable and maintainable goals, which may be limited to stopping weight gain, stabilizing weight, or even achieving a series of small weight losses. Treatment should emphasize a woman's overall health, which is being threatened by obesity. Replacing the health risks of obesity with another set of health risks that might accompany treatment makes little sense.

There are three main directions for the treatment of obesity: dietary, pharmacological, and surgical. As I mentioned above, dietary changes are unavoidable. Pharmacological treatment is effective but limited in several important ways. There are some very serious side effects associated with many of the drugs used to combat obesity, including pulmonary complications (recently in the news with regards to "Fen-Phen"). There is also the risk of over-dependence on drugs, leading a woman to relax her dietary changes. Most importantly, it is extremely difficult to maintain weight loss after discontinuing drugs.

Because treating obesity is difficult, and very often frustrating for the person suffering from obesity, some women consider the option of surgical treatment. There are three types of surgery used to treat obesity.

The first is a "banding" or "stapling" of the stomach, which acts to decrease the capacity of a person's stomach. Food enters this smaller stomach normally, but is released more slowly, and piece meal, through a small opening at the base of this false stomach. This makes a person feel full more quickly, and only allows for a certain amount of food to be consumed.

Second is a procedure called gastric bypass. This surgery works in two ways. First, it creates a smaller stomach pouch, like in the procedure described above. But rather than passing through the bottom of this pouch and into the stomach, food bypasses the lower stomach and the first portion of the intestinal tract completely. This reduces calorie, and nutrient absorption.

The third type of surgical procedure (extensive gastric bypass) is a still more drastic version of the last. Portions of the stomach are removed and the entire upper part of the small intestine is bypassed. This procedure works in the same way as the gastric bypass, reducing both the amount of food consumed and the absorption of calories and nutrients.

All three of these procedures are quite effective at helping a person lose weight, and keep it off, but they are also a quite drastic means to weight loss. If a woman's general health is being seriously threatened by her obesity, than the risks of these procedures may be outweighed. A surgical course of treatment is usually only recommended to women whose health is seriously at risk. These treatments should only be considered when a woman has explored all other options, and has given those options enough time to show results. This can be frustrating, and sometimes fruitless, but gastric bypass surgery requires lifelong medical follow-up, and must be accompanied by dietary restrictions.

With all of these procedures food has to be eaten in small bites and chewed thoroughly or a person will easily vomit. As with most surgical procedures, there is a risk of wound infection, and excessive bleeding. Staples, or bands may weaken and allow stomach fluid to leak into the abdomen. Gastric bypass can cause the stomach contents to move too quickly through the small intestine, leading to "dumping syndrome", symptoms of which are diarrhea, nausea, weakness, sweating, and faintness as well as an inability to eat sweets without becoming weak, and sweaty.

One of the biggest side effects of gastric surgery results from the reduction of calorie and nutrient absorption. Because gastric bypass operations cause food to bypass the stomach and parts of the small intestine, where most of the iron and calcium from food is absorbed, women run the risk of anemia, developing osteoporosis, and other nutritional deficiencies. Nutritional supplements can counteract these deficiencies, but they must be taken life-long. The more extensive the operation, the greater the risk is for complications and nutrient deficiencies.

Ten to 20% of people who choose this option have to have follow-up operations to correct complications (abdominal hernias being the most common), and more than one third develop gallstones from the rapid weight loss. The risk of developing gallstones can be countered though by taking supplemental bile salts for a short time after surgery. If a woman for any reason believes she might be pregnant, she should avoid such severe weight loss, or wait to become pregnant until her weight has stabilized.

This is clearly a difficult decision, and one that should only be made after receiving all available information on the potential risks and benefits. There are many online resources available on gastric bypass surgery and obesity. Additionally, since this surgery requires life-long medical follow up she should consider the potential financial cost of nutrient supplements and possible complications.

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