The problem of overweight is becoming increasingly threatening the health of Americans. In the USA overweight is 35-40% of the population, and obesity affects 20%. Ten years ago, every 9th schoolchild suffered from obesity, and today every fourth student.
The leading cause of obesity is a violation of diet: an abundance of semi-finished products, fatty fried foods, fast foods. If a sedentary lifestyle supplements this, obesity is “just around the corner”.
And its main danger is diseasing, the development of which it contributes: diabetes, cardiovascular pathologies, arthritis. Doctors have long been sounding the alarm: obesity has become a national disaster and increasingly requires surgical treatment.
With the help of one diet, it is not often possible to change the menu for a long time, so many are in a closed circle – then losing weight, then again gaining weight, rush from one diet to another (the so-called pendulum effect). Others resort to means to suppress appetite, but even in this case, side effects can prevent the achievement of a cherished goal.
What kind of surgery for weight loss you can choose?
The choice of surgery for weight loss is primarily determined by the Body Mass Index (BMI), which can be calculated using the formula: weight (kg) divided by Height (m) in the square:
- If your body mass index is 30 to 40, it is too early to talk about surgery, other methods of weight loss should be used, for example, put an intragastric balloon (this method is not an operation).
- On the other hand, if you have such diseases as high blood pressure, or diabetes, or problems with leg joints, or varicose veins, then the BMI needed for surgery can be reduced to 35.
- If your BMI is 40-50, then most likely you need to put a restrictive adjustable ring on the stomach – gastric banding.
- If your BMI is more than 50, the operation is most suitable for you, such as gastric bypass surgery, since the application of the ring to the stomach is most likely not so effective. Bypassing the stomach gives the most substantial effect with the smallest number of possible long-term consequences.
Endoscopic installation of an intragastric balloon
As an interim measure for weight reduction, an intragastric balloon is used. This method is not an operation. The intragastric balloon is a silicone ball filled with liquid in a volume of “0.5” liter. Filling the part of the intragastric space, and also, acting on the nerve endings, the balloon imitates a feeling of satiety. Thanks to the installation of the gastric balloon the patient can lose 15 – 20 kg.
However, it must be remembered that not all are well tolerated by the presence of a large foreign body in the stomach. Also, six months after the balloon is installed, it must be removed to avoid the development of complications. At the same time, if a new balloon is not placed the lost kilograms can return in excess.
Adjustable gastric banding
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The purpose of the operation is to decrease the amount of food eaten dramatically, and, accordingly, to reduce the number of calories consumed. This goal is achieved by imposing a special silicone ring (bandage) on the upper part of the stomach, immediately under the esophagus.
The superimposed ring gives the stomach the shape of an hourglass. A minimal amount of food, getting into a small part of the stomach and lingering in it, causes stretching of the stomach walls, which usually happens only when the stomach is full. Particular nerves of the upper part of the stomach signal to the brain: “I’m full” After a year and a half after this operation, you can lose 50 to 70% of the excess weight.
Gastric and biliopancreatic diversion
An operation that combines a decrease in the stomach and a reduction in the absorption of nutrients is the operation of gastric bypass surgery. Its essence lies in the fact that a “small ventricle” of 50 ml volume is created by crossing the stomach in the upper part, and then a loop of the small intestine is sewn to this “small ventricle”. At the same time the food goes along a short path, and a half – to restore the patency of the gastrointestinal tract.
Also, the intestines are reconstructed in such a way that the digestive juices of the pancreas and bile are met with food only after passing one and a half meters of the small intestine. Thus, due to the reduction of the stomach, the effect of a small amount of food eaten is achieved, and its “idle” transport through the small intestine leads to a decrease in the absorption of nutrients. After a year and a half after this operation, you can lose from 70 to 100% of the excess body weight.
How does the process of digestion change after surgery?
Digestion involving bile acids and pancreatic enzymes begins only at the end of the small intestine, throughout the entire 50-100 cm (instead of several meters of the active surface of the small intestine, as should be standard). Such an operation, which significantly changes the configuration of the intestine, is accompanied, as a rule, by the concomitant removal of the appendix and gallbladder.
Technically, this is a fairly responsible cavitary operation with the use of general anesthesia, muscle relaxants and an artificial ventilation device. The surgeon usually performs the maximum operational volume due to the development in the future of a vast adhesion process, in which it is complicated to “enter” again to the abdominal cavity and make the necessary manipulations in emergency cases.
A common property of these (crippling, in my opinion) operations is a significant disruption of the digestive system, making it untenable to the functions inherent in it by nature itself. The state of digestion in a person with a large part of the stomach removed and practically “off”, most of the small intestine, worsens the whole composition of healthy intestinal microflora changes significantly. The sequence and intensity of the intake of components of nutrients in the body are also severely disrupted, which in turn leads to an adaptive rearrangement of all metabolic processes in the body.
Within 12-24 months after the operation, the pregnancy is contraindicated for patients. In the future, pregnancy is possible, but it is necessary to consult a specialist and regularly monitor the doctor throughout the formation of the fetus. We well know that even a sick tooth can cause a healthy person to have digestion and normal gastrointestinal function, which can worsen the quality of life and lead to some chronic diseases. What can we say about the quality life of a man with a mutilated digestive tract?
Possible risk and complications
Artificially induced malabsorption syndrome disrupts the normal functioning of the kidneys, liver, pancreas and other internal organs. As a rule, dysproteinemia develops (a violation of protein metabolism), as well as a violation of the exchange of minerals, which in turn in the first months after the operation can cause a sharp general weakness, as well as total hair loss. Increased brittleness of the nails, dry skin and dermatitis, as well as major hemorrhagic spots caused by hemorrhages in the skin due to a violation of blood coagulability.
Glossitis (inflammation of the tongue) and deterioration of all mucous membranes associated with insufficiency of vitamins (especially folic acid, vitamin C and B 12) and iron. In recent years, cases of a sharp drop in vision, also associated with a violation of absorption and assimilation of vitamins, are described. In patients, there is a violation of hormonal and electrolyte balance of blood, anemia due to vitamin B deficiency develops. 12. Osteoporosis increased bleeding, a tendency to thrombosis, constant development of pulmonary complications (pneumonia, atelectasis), frequent stools several times a day and diarrhea for life) – this is far from a complete list of “unpleasant” side effects of these operations.
To somehow facilitate further life, patients are offered a whole range of medicines, multivitamins, food additives with minerals, which he must consume regularly. The cause of death after bariatric surgery may be pulmonary embolism or other complications associated with disruption of organs and systems. We should not forget about the possible infectious complications from the wound and the formation of a postoperative hernia, insufficiency of sutures and anastomosis of the intestine. Operations performed in patients with severe obesity and so in themselves are quite complex. Such patients are more likely to experience postoperative complications. A clear adhesion process practically always develops after these procedures.
How effective are these surgeries to reduce excess weight?
The most surprising thing is that even after such radical influences, the effect of losing weight is only temporary. Without strict adherence to a low-calorie diet, which is necessarily recommended to a patient in the postoperative period, his weight soon begins to return to preoperative figures. This is truly the great power of life and struggles for it, embedded in our body by nature itself! Despite all the damage caused to the body (albeit in a sterile operating room), it maximizes its functions, returning “status quo!”.
In my opinion, these radical methods have nothing to do with the treatment of obesity, since, once again, I do not want to eliminate the causes of its occurrence. This purely mechanical and technical approach to the treatment of obesity causes its insufficient effectiveness.
As you understand, obesity arises in patients not because they have too much-digested food or too long and healthy intestines. All of this nature has equipped a person without any redundancy. There is nothing superfluous or wrong in our body! In most cases, patients with metabolic and weight disorders have abnormal eating behavior. In this case, such crippling operations should be considered as attempts to remove the manifestations of the disease by any means (namely manifestations, not the disease itself). Is it possible to call an improvement the postoperative state in which a person will stay after the completion of a surgical intervention? A serious assessment of the patient’s condition is required so that the risk of these surgical interventions does not exceed the risk of having obesity itself.
From further management of such patients, I want to note that this becomes more difficult, because to the existing violation of the food stereotype is also added an organic violation of the digestive tract, which in itself is already subject to constant medical control. Such operations can be shown only in exceptional cases when there is no way to help the patient with other methods. In this case, it is necessary to inform him of all possible complications and violation of the quality of life associated with the operation. Moreover, these violations remain for life.
Recent research has shown that the gastrointestinal tract (GIT) is a complex neurohumoral system, a powerful endocrine and exocrine (hormonal) apparatus that has its memory and automatism. This system has a continuous and intense impact on the central nervous system, and directly determine our quality of life. To cripple such a system, in my opinion, is impossible.
Life after weight loss surgery
The operation for weight loss should be the beginning of a new way of life. To achieve maximum results, having decided on surgery, it is necessary:
- Say goodbye to the habit of eating a lot. Almost all obese people have a habit of eating unhealthy food. The common problem of losing weight is “overeating”. But after surgery has entered the field, eating large amounts of food can lead to serious problems. For most people, it is challenging to train yourself to eat often, but a little bit.
- Eat healthy foods and drink vitamins. If there is harmful food and do not drink vitamins, then surgery for weight loss can lead to severe problems. So after the operation for weight loss can appear bone disease, decrease muscle tone, hemoglobin level (anemia).
- Do exercise for weight loss. Maintain weight after losing weight (even if you used surgery) is much more comfortable if you live an active lifestyle. Physical activity reduces the risk of many diseases, including cancer and cardiovascular diseases. To lose weight and maintain weight at the proper level, you must perform physical exercises.
For most people, it is not so easy to fundamentally change your way of life after they have used surgery for weight loss. Many centers for weight loss offer special programs to help people move to a new lifestyle after surgery for weight loss.