It’s a simple message: If you want to drop some weight, you have to make an effort to eat less food and exercise more frequently. For some overweight people, shedding pounds is a lot tougher than one might think. When diets and exercise don’t work out, some individuals begin to consider medical obesity treatments or weight loss surgery options.

Obesity Facts

Obesity is widespread throughout the United States. The latest research indicates that about one third of Americans is obese. In fact, nearly 300,000 U.S. deaths every year are tied to obesity.

When is someone obese? He or she must weigh at least 100 pounds more than the ideal body weight or if the body mass index (BMI) is more than 35 The BMI, a mathematical formula, considers an individual’s height and weight to determine whether they are obese. A morbidly obese person has a BMI of 40 or greater. Candidates for obesity weight loss surgery include those with a BMI of 40 or more or individuals with a BMI or 35 or more with serious health conditions.

Obesity Surgery

Two obesity surgery procedures performed at Cleveland Clinic include gastric bypass surgery and adjustable gastric banding. For individuals who need to lose weight, bariatric surgery (also called gastric bypass, banding or weight loss surgery) has an excellent long-term track record. Long-term lifestyle changes are necessary for obesity, a chronic condition. Anyone contemplating surgical weight loss must expect to continue with the lifestyle changes and understand the surgery risks and benefits.

The information on our web site details Cleveland Clinic bariatric surgery procedures. We also explain why the process should be fully evaluated before deciding on obesity surgery.Each year, more than 400,000 deaths in the United States are linked to obesity. Today, clinicians realize obesity is a chronic condition requiring long-term lifestyle changes.

Cleveland Clinic's Bariatric and Metabolic Institute may offer a solution with surgical weight loss. The extensive evaluation process involves working with a team of specialists, including an endocrinologist, nutrition therapist, psychologist, nurse and surgeon.

Along with careful follow-up, monthly informational meetings and support groups to meet individual needs complement this process.

For information: call 216.445.2224 or toll-free: 800.223.2273, ext. 5-2224.

The Roux-en-Y gastric bypass is the most common and successful type of gastric bypass procedure. The surgeon begins by creating a small pouch by dividing the upper end of the stomach. This restricts the intake of food. Next, a Y-shaped section of the small intestine is attached to the pouch to allow food to bypass the lower stomach, the duodenum (the first segment of the small intestine), as well as the first portion of the jejunum (the second segment of the small intestine). The procedure creates a direct connection from the stomach to the lower segment of the small intestine, literally bypassing portions of the digestive tract that absorb calories and nutrients.

Expected Weight Loss

Patients who have malabsorptive surgery generally lose one-half to two-thirds of their excess weight within two years. The weight loss generally continues for a year and a half before stabilizing.

Benefits of Bypass Surgery

Few surgical risks and more weight loss

Unlike bypass procedures that involve removal of the stomach, the Roux-en-Y approach poses fewer operative risks. Malabsorptive procedures, like the Roux-en-Y, produce more weight loss than restrictive surgeries and are more effective in reversing the health problems associated with severe obesity. Patients feel full after eating about two tablespoons of food. Due to some malabsorption, nutritional supplements are necessary.

Surgical Risks

Complications can be avoided with proper care

First, you should know that all surgical procedures have risks, particularly for morbidly obese individuals. Discuss potential risks of surgery with your surgeon so that you are prepared to make an informed choice.

The risk of complications and nutritional deficiencies is higher with a more extensive bypass operation. Patients with extensive bypasses of the normal digestive process require not only close monitoring, but also lifelong use of special foods and medications. Ten percent to 20 percent of patients who have weight loss operations require follow-up operations to correct complications. Abdominal hernias are the most common complications requiring follow-up surgery.

Complications also may include leakage through staples or sutures, bowel obstruction, ulcers in the stomach or small intestine, blood clots in the lungs or legs, stretching of the pouch or esophagus, recurring vomiting and abdominal pain, inflammation of the gallbladder, and failure to lose weight.

More than one-third of obese patients who have gastric bypass surgery develop gallstones (clumps of cholesterol and other matter that form in the gallbladder). During rapid or substantial weight loss, a person’s risk of developing gallstones is increased. Gallstones can be prevented with bile salt supplements taken for the first six months after surgery.

Nearly 30 percent of patients who have weight loss surgery develop nutritional deficiencies such as anemia, osteoporosis and metabolic bone disease. These deficiencies can be avoided if vitamin and mineral intakes are maintained.

Dumping syndrome”, in which consumption of certain foods and beverages causes abdominal cramping and diarrhea, can also occur. Your registered dietitian will explain how to prevent dumping syndrome.

Finally, you should know that surgeons with more experience performing this procedure report fewer complications.

About Bariatric Surgery Treatments

There are two ways in which weight loss surgery achieves its goals.

One way is shrinking the stomach. It’s known as restrictive because it limits how much food can be taken in. The other type of weight loss surgery is the malabsorptive technique. It has this name because it limits and hinders the amount of calories the body can absorb.

We offer two methods of surgery: Roux-en gastric bypass and a process known as adjustable gastric banding. The Roux-en- gastric procedure merges both the restrictive and the malabsorptive procedures. The adjustable gastric banding process (LAP-BAND) limits how much food can be consumed.

No method of surgery, neither gastric banding nor gastric bypass, is guaranteed, and your results with weight loss surgery can vary. Your dedication to making it work (including a new diet and way of life) will ultimately determine the success of any procedure.

Bariatric surgery promotes weight loss by two different methods. The surgical options we offer at Cleveland Clinic are Roux-en-gastric bypass and adjustable gastric banding.

Setting Realistic Expectations

To be successful and gain all the health benefits that bariatric surgery has to offer, you must make major changes in your daily eating habits and develop a healthy lifestyle, including a program of regular physical exercise.

Surgery Overview

Learn more about the digestive process and how safe weight loss surgery procedures are performed at Cleveland Clinic.

What Are the Risks?

The more extensive the weight loss operation, the greater the risk is for complications and nutritional deficiencies. Patients who undergo a bypass of the normal digestive process require close monitoring for safety, and lifelong addition of vitamins and minerals.

Results of Weight Loss Surgery

Most patients will lose about 60 to 80 percent of their excess body weight with the gastric bypass procedure, with substantial weight loss occurring 18 to 24 months after surgery.

Bariatric Surgery at Cleveland Clinic

At every step of the way, the staff of the Bariatric and Metabolic Institute focuses on your safety and your comfort. In addition, you have access to some of the world’s best physicians in other medical specialties.

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