910-295-6831 | Toll-free 800-755-2500General and Bariatric Center
Surgical Treatment of Morbid Obesity
What is morbid obesity?
Morbid obesity is a term used to describe a condition when a person has a Body Mass Index (BMI) of 40 or more. This is roughly equivalent to being 100 pounds or more over ideal body weight. The term "morbid" refers to the fact that such a weight level is life threatening.
Why is a high Body Mass Index life threatening?
Recent studies have shown that a person who is morbidly obese has twice the likelihood of an early death than a non-obese person. Too much weight can lead to any one or more of the following problems:
- Type 2 diabetes
- Certain cancers
- Heart disease, high blood pressure, and stroke
- Sleep apnea and other breathing problems
- Back or joint problems
- Problems with urination or menstruation
Who should get surgical treatment for morbid obesity?
Because surgery alone is only a part of a treatment for morbid obesity, a person who is considering the procedure (sometimes referred to as bariatric surgery) needs a commitment to a range of solutions including diet and exercise. The American National Institutes of Health recommends that a good candidate for this surgery have the following:
- A Body Mass Index of 40 or more, or 100 pounds or more over ideal body weight
- A Body Mass Index of 35 or more with other obesity-related health problems
- A history of dietary weight loss attempts
- A commitment to dietary, exercise, medical guidelines, and care
- A mental and emotional preparedness to make lifelong lifestyle changes
- A good support system
A team of different health care professionals will evaluate a candidate to determine final suitability. Surgery for morbid obesity is a life-changing procedure that requires careful consideration by the doctor and the patient. It is not done for cosmetic reasons.
What happens in surgical treatment for morbid obesity?
There are many types of bariatric surgery but two basic methods of achieving weight loss.
- Restrictive procedures – In these, weight loss is accomplished by making the stomach pouch smaller. Then during eating, the pouch fills quickly and gives a feeling of fullness much sooner. Because a patient feels satisfied and full sooner, he or she will eat less. There are two types of restrictive surgery. In laparoscopic adjustable gastric banding surgery, a small band is placed around the top part of the stomach, creating a small pouch, the size of which is adjustable. The other type of restrictive surgery is called vertical banded gastroplasty. Staples and a non-adjustable band are used to create a similar result
- Malabsorptive procedures – Here the surgeon rearranges the small intestine, rerouting food past a large part of the stomach. In this way much of the calories and nutrients pass through the body without being absorbed. One type of malabsorptive surgery is roux- en-Y gastric bypasss, where the small intestine is cut and reattached, leaving a shorter path for food to travel through.
A combination of restrictive and malabsorptive surgery may also be used.
Is surgical treatment for morbid obesity safe?
In general, yes, but the risks must be weighted against the benefits. Some of the risks involve:
- Infection
- Leakage or bleeding at the site of surgery
- Breathing problems that may require ventilation or a tracheotomy
- Blood clots in the legs or lungs
- Need for removal of the spleen
- Recurrent vomiting
- Incisional herniav
- Gallstones that may require removal of the gallbladder
- Anesthesia problems
Because the stomach may not be able to absorb all the nutrients the body requires, vitamin and mineral supplements will be needed for life. Likewise, dehydration can be a problem and sufficient liquid intake must be maintained. Temporary hair loss can occur after surgery.
How much weight can a patient lose from surgery?
Surgical treatment for morbid obesity does not instantly mean weight loss. Usually, a patient loses weight gradually over a period of six months to a year. About half the excess weight is lost during the first 18 months. It is not expected that a patient will lose all his or her excess weight, but will achieve a more healthy weight.