Surgery and other procedures

One third to one half of all obese persons will not lose weight by any medical method and weight loss surgery (also known as bariatric surgery) should be considered in some situations. It should be considered for people with a BMI of 35 with significant co-morbidities such as diabetes.

Weight loss surgery is approved by the National Institute for Clinical Excellence (NICE), who recommend it as first line treatment when a person’s BMI is 50.

Studies have shown major benefits, as a consequence of gastric surgery, on non-insulin dependent diabetes mellitus, hypertension, hyperlipidaemia, cardiovascular disease, sleep apnoea, asthma and quality of life. Life expectancy has been improved.

Surgery has been divided into two types, restrictive and malabsorptive. Weight loss of 40% to 70% of excess weight occurs, which steadies out at around 2 years. In 20% to 30% of patients surgery is not effective or side effects are experienced.

Restrictive

This includes laparoscopic gastric banding, which is a popular operation in this country. The capacity of the stomach is drastically reduced and meals are smaller. An inflatable band is placed around the upper part of the stomach, which can be inflated by access to a small port accessible through the skin.

Malabsorptive

This can involve a gastric bypass operation, called a Roux-en-Y operation.

A small stomach pouch is fashioned by stapling across the stomach. This is connected to a part of the small intestine. The lower part of the stomach, duodenum and the upper jejunum of the small intestine are by-passed. Usually, nutrients such as iron, calcium, vitamins and B12 have to be supplemented.

In the UK, the most frequently performed procedures are laparoscopic gastric banding and laporoscopic gastric bypass. Complications, which can occur, are technical problems from the operation itself and from pulmonary embolus (blood clot on the lung). Gastric banding is the less complicated procedure with less chance of side-effects. However, weight loss is slower.

Other procedures

Plastic surgery such as apronectomy, to remove skin folds left after significant weight loss, may be offered when the weight loss is maintained for a year. However, in reality, less than 10% of people will get this surgery.

Amended November 2009