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Tuesday, March 15, 2011

Bariatric (Weight Loss) Surgery

The American Heart Association just issued a statement that the benefits of bariatric (weight loss) surgery may outnumber the risks in some obese patients. Weight loss surgery is usually performed on men who are at least 100 pounds overweight and women who are at least 80 pounds overweight. (National Institute of Diabetes and Digestive and Kidney Diseases)

There are four types of operations that are commonly offered in the United States: adjustable gastric band (AGB), Roux-en-Y gastric bypass (RYGB), biliopancreatic diversion with a duodenal switch (BPD-DS), and vertical sleeve gastrectomy (VSG).

Here are the descriptions of each type of surgery from the National Institute of Diabetes and Digestive and Kidney Diseases-NIDDK (there's a link at the end of these descriptions to the NIDDK web site):

Adjustable Gastric Band AGB works primarily by decreasing food intake. Food intake is limited by placing a small bracelet-like band around the top of the stomach to produce a small pouch about the size of a thumb. The outlet size is controlled by a circular balloon inside the band that can be inflated or deflated with saline solution to meet the needs of the patient.

Roux-en-Y Gastric Bypass RYGB works by restricting food intake and by decreasing the absorption of food. Food intake is limited by a small pouch that is similar in size to the adjustable gastric band. In addition, absorption of food in the digestive tract is reduced by excluding most of the stomach, duodenum, and upper intestine from contact with food by routing food directly from the pouch into the small intestine.

Biliopancreatic Diversion With a Duodenal Switch BPD-DS, usually referred to as a “duodenal switch,” is a complex bariatric operation that principally includes 1) removing a large portion of the stomach to promote smaller meal sizes, 2) re-routing of food away from much of the small intestine to partially prevent absorption of food, and 3) re-routing of bile and other digestive juices which impair digestion.

In removing a large portion of the stomach, a more tubular “gastric sleeve” (also known as a vertical sleeve gastrectomy, or VSG) is created.

The smaller stomach sleeve remains connected to a very short segment of the duodenum, which is then directly connected to a lower part of the small intestine. This operation leaves a small portion of the duodenum available for food and the absorption of some vitamins and minerals.
However, food that is eaten by the patient bypasses the majority of the duodenum. The distance between the stomach and colon is made much shorter after this operation, thus promoting malabsorption. BPD-DS produces significant weight loss. However, there is greater risk of long-term complications because of decreased absorption of food, vitamins, and minerals.

Vertical Sleeve Gastrectomy VSG historically had been performed only as the first stage of BPD-DS (see above) in patients who may be at high risk for complications from more extensive types of surgery. These patients’ high risk levels are due to body weight or medical conditions. However, more recent information indicates that some patients who undergo a VSG can actually lose significant weight with VSG alone and avoid a second procedure. It is not yet known how many patients who undergo VSG alone will need a second stage procedure. A VSG operation restricts food intake and does not lead to decreased absorption of food. However, most of the stomach is removed, which may decrease production of a hormone called ghrelin. A decreased amount of ghrelin may reduce hunger more than other purely restrictive operations, such as gastric band.

(For more information on these types of surgeries and to see diagrams of each one, check out Bariatric Surgery for Severe Obesity from the NIDDK.

If you’re interested in reading the complete American Heart Association Statement, check out Bariatric Surgery and Cardiovascular Risk Factors

Other links you might find helpful:

Gastric Bypass Surgery: Who Is It For? (Mayo Foundation for Medical Education and Research)

Gastric Bypass Surgery (Mayo Foundation for Medical Education and Research)

Weight Loss Surgery (UpToDate)

Calculate Your Body Mass Index (National Heart, Lung, and Blood Institute)


  1. Some patients who undergo bariatric gastrointestinal surgery lose more than 100 pounds of weight - some lose as much as 200 pounds. Some bariatric surgeons accept patients in their 60's, and some even operate on teenagers.

  2. Bariatric loss surgery for overweight people to regain their health, and by extension, their lives. Obese patients who continue to work after the new, healthy lifestyle, find themselves greatly reduced the risk of disease. Perhaps equally important, who experience a lot of weight, many people feel better about themselves, their appearance, and their future.