Calculating your BMI

The first thing your doctor might do as he or she decides if you are a candidate for weight loss surgery is to determine your body mass index (BMI). Body mass index (BMI) is a measure of body fat based on height and weight that applies to both adult men and women. This number is calculated by dividing a patient’s mass ( in kilograms) by his or her height ( in meters, squared). A normal BMI is considered in the range of 18.5 - 24.9 kg/m². A BMI of 25 - 29.9 kg/m² is considered overweight. A BMI of 30 kg/m² or greater is classified as obese; this classification is further subdivided into class I, II, or III obesity.

Bariatric surgery is most appropriate for people with a BMI of 40 or more or who also have serious health complications related to obesity.In general, weight loss surgery is considered for people with Class II obesity if they have obesityrelated illnesses and Class III obesity with or without related illnesses.

How Affective Is Bariatric Surgery?

The actual weight a patient will lose after the procedure is dependent on several factors. These include:

• Age
• Pre-surgery weight
• Overall health
• Surgical procedure
• Ability to exercise
• Commitment to diet, exercise and follow-up care
• Motivation
• Cooperation of family, friends and associates

Successful Weight Loss

Weight loss surgery is considered successful when a patient loses 50% or more of excess body weight (the "overweight") and keeps the weight off for at least five years.

Clinical studies show that, in general, patients:

• Lose weight for 18-24 months after the procedure
• Lose 30-50% of excess weight in the first six months and 77% of excess weight within 12 months of surgery
• Maintain a 50-60% loss of excess weight 10-14 years after surgery
• With higher initial BMI’s lose more total weight
• With lower initial BMI’s lose a greater percentage of excess weight and come closer to their ideal body weight
• With Type 2 Diabetes lose less excess weight than patients without Type 2 Diabetes
• Very few people reach their ideal body weight this is not the goal of bariatric surgery

Potential benefits of gastric bypass

Patients who have gastric bypass surgery often lose more weight, lose weight more quickly and keep more weight off for longer periods of time than those who have other forms of bariatric surgery. However, individual results depend on many factors, including the type of procedure performed and the commitment of the patient to making the necessary dietary and lifestyle adjustments. Age, gender and initial weight at the time of the surgery may also play a role in the outcome.

Patients often report higher self-esteem and better general health, including having more endurance to carry out daily tasks. Gastric bypass surgery may also lengthen a patient’s lifespan and help improve symptoms of conditions related to obesity, including:

• Hyperlipidemia is corrected in over 70% of patients.
• Essential hypertension is relieved in over 70% of patients, and medication requirements are usually reduced in the remainder.
• Obstructive sleep apnea is markedly improved with weight loss, so that most patients are asymptomatic, and often do not even snore, within one year.
• Diabetes mellitus type 2 is reversed in up to 90% of patients, usually leading to a normal blood sugar without medication, sometimes within days of surgery.
• Gastroesophageal reflux disease is relieved from the time of surgery in almost all patients.
• Venous thromboembolic disease signs such as leg swelling are typically much improved.
• Low back pain and joint pain are typically relieved or improved in nearly all patients.

A recent study in a large comparative series of patients showed a 89% reduction in mortality over the 5 years following surgery, compared to a nonsurgically treated group of patients. There were accompanying decreases in the incidence of cardiovascular disease, infections, and cancer. Concurrently, most patients are able to alter their
lifestyle, to consume "healthier" foods, exercise more regularly, and to enjoy greater participation in family and social activities. Bariatric surgery is the most effective treatment for morbid obesity, and can markedly improve health and lifestyle.

What lifestyle changes will you have to make?

In order to make the most of your weight loss surgery, you’ll need to change your lifestyle after the surgery. Here are some changes you’ll need to make:

• You’ll need to restrict your diet and take supplements. Because the size of your stomach has effectively been reduced to about the size of 1 cup or less, your meals will be in smaller portions. You’ll have to eat more frequently throughout the day, and you’ll need to make sure you chew your food slowly and thoroughly, so it doesn’t become stuck and so it’s properly digested. You’ll need more time to eat than you used to, but you’ll also notice you feel fuller with less food. You wont drink any beverages with your meal - your stomach will be too small to hold both. If you had gastric bypass surgery, you’ll be absorbing fewer nutrients than you did before the surgery, so to prevent deficiencies, you’ll need to commit to a regimen of vitamin supplements for the rest of your life.
• You’ll need to exercise regularly. Exercise is even more important to the weight loss surgery patient. After surgery, you’ll be losing weight very rapidly. When this happens, your body will burn stored fat and muscle. Exercise as well as eating more protein are important in countering this by building muscle, burning fat, and increasing your metabolism. Exercise will also be crucial in helping you maintain your weight loss and health lifestyle for the long term.
• You’ll need to work through any psychological and emotional issues. Many people mistakenly assume that weight loss surgery will be a quick fix to all their problems. You have your own issues going into the surgery, and chances are you’ll still have them after surgery. Weight loss surgery will affect most aspects of your life, including your family, career, social life, and self-esteem. You’ll be faced with a lot of changes, most of them good. But any change - good or bad - causes some degree of stress and anxiety. Participating in a support group or getting professional help through a counseling will be helpful in overcoming these and the many other challenges that you’ll experience along your journey.

Points to Consider

• Are you ready to make a lifelong commitment to improved health?
• Am I convinced I can't lose weight any other way? Have I tried every other option?
• Have I researched all aspects of bariatric surgery?
• Am I committed and willing to lose weight and improve my health? Will I stick to my dietary guidelines? Exercise regularly?
• Can I manage how my life will change after surgery?
• Will I be able to eat small, healthful meals and chew each bite thoroughly and slowly?
• Do I understand the risks of potential complications?
• Will I maintain a regular schedule of doctor appointments for the rest of my life?

Weight loss surgery is major surgery. You should only make the decision after careful evaluation and consultations with an experienced bariatric surgeon. Here are some important considerations to keep in mind and discuss with your doctor:

• Weight loss surgery should not be considered cosmetic surgery.
• The surgery does not remove fat (like liposuction does).
• Your current health risks must be weighed against the risks of surgery.
• Bariatric surgery is not meant to be reversible.
• Weight loss surgery can only be successful with long-term changes in diet, exercise, and lifestyle and strict follow-up care.
• Problems can arise that require re-operations.
• Bariatric surgery should only be considered after all other less invasive options, such as medically-supervised weight loss programs, have been tried to exhaustion.
• Weight loss surgery will dramatically alter your life-physically, emotionally, financially - and relationships with people and food.

What other factors are used to determine if a person is a good candidate for bariatric surgery?

For most people, BMI is the most important factor However, your doctor needs to carefully consider your current physical and emotional health as well. For example, if you have recently had cancer treatment, major surgery, a heart attack, or a cardiac procedure, your doctor may feel that you should wait a period of time before considering bariatric surgery. With regard to emotional health, people with a history of anorexia nervosa are generally not considered good candidates for this surgery. Likewise, uncontrolled bulimia is generally a contraindication for bariatric surgery. If you have had an eating disorder in the past but have been well controlled for a long time, your doctor may consider you a good candidate.

Finally, if you have long-standing psychiatric difficulties such as schizophrenia or manic depression you are unlikely to be a good candidate for weight loss surgery. I would like to emphasize that these criteria are simply rules of thumb; nothing is in stone. Each person has a unique set of circumstances. The final decision is ultimately up to you, your personal physician, and your bariatric surgeon.

Understanding the gastrointestinal tract

To better understand how bariatric surgery works, it i s important to understand how your gastrointestinal tract functions. As the food you consume moves through the tract, various digestive juices and enzymes are introduced at specific stages that allow absorption of nutrients. Food material that is not absorbed is then prepared for elimination. The major functions of the GI tract are ingestion, digestion, absorption, and defecation. A simplified description of the gastrointestinal tract appears below.

• The esophagus is a long, muscular tube that moves food from the mouth to the stomach.
• The abdomen contains all of the digestive organs.
• A valve at the entrance to the stomach from the esophagus allows the food to enter, while keeping the acid-laden food from “refluxing” back into the esophagus, causing damage and pain.
• The stomach, situated at the top of the abdomen, normally holds just over 3 pints (about 1,500 ml) of food from a single meal. Here, the food is mixed with an acid that is produced to assist in digestion. In the stomach, acid and other digestive juices are added to the ingested food to facilitate breakdown of complex proteins, fats, and carbohydrates into small, more absorbable units.
• The pylorus is a small, round muscle located at the outlet of the stomach and the entrance to the small intestine. It closes the stomach outlet while food is being digested into a more easily absorbed form. When food is properly digested, the pylorus opens and allows the contents of the stomach into the first portion of the small intestine.
• The small intestine is about 15 to 20 feet long and is where the majority of absorption of the nutrients from food takes place. The small intestine is made up of three sections: the duodenum, the jejunum, and the ileum.
• The duodenum is the first section of the small intestine and is where the food is mixed with bile produced by the liver and with other juices from the pancreas. This is where much of the iron and calcium is absorbed.
• The jejunum is the middle part of the small intestine extending from the duodenum to the ileum; it is responsible for absorption of nutrients.
• The last segment of the intestine, the ileum, is where the absorption of fat-soluble vitamins A, D, E, and K and other nutrients occurs.
• Another valve separates the small and large intestines to keep bacteria-laden colon contents from flowing back into the small intestine.
• In the large intestine, protein and excess fluids are absorbed and a firm stool is formed.