The Underused Weight Loss Option: Bariatric Surgery – The New York Times

Although guidelines set in 1991 limit recommendations for bariatric surgery to those most severely affected by obesity, current evidence indicates that young people who are not yet morbidly obese may be especially likely to benefit from weight-loss surgery. Most adolescents who are obese remain obese as adults and have worse medical outcomes than people who became obese as adults. The surgical route is now sometimes offered to adolescents and young adults with obesity-related health problems like Type 2 diabetes that have failed to yield to diet and exercise.

In a study reported by the University of Pittsburgh Graduate School of Public Health that followed 2,221 patients, within three years of bariatric surgery, most experienced less pain and improved ability to walk. But as with any weight-loss program, such benefits as well as lasting weight management depend on whether patients stick to a healthful diet and exercise regimen after the surgery.

The original bariatric technique, called Roux-en-Y gastric bypass, reduces the stomach to the size of an egg and bypasses a major portion of the small intestine to limit caloric absorption. A now-retired friend who underwent this operation 15 years ago lost 160 pounds and has kept all but 10 pounds off despite traveling widely on vacations, a time when people often gain weight.

However, in recent years, gastric bypass has yielded to a newer, less involved operation called sleeve gastrectomy that has fewer complications yet excellent long-lasting results.

According to the American Society for Metabolic and Bariatric Surgery, only 1.5 percent of patients undergoing sleeve gastrectomy require a reoperation because of complications, as against 7.7 percent undergoing gastric bypass and 15.3 percent who have a less effective procedure called lap band surgery, in which a band placed around the stomach divides it into two pouches.

In sleeve gastrectomy, about 85 percent of the stomach is removed, resulting in a banana-shaped pouch that limits the amount of food that can be consumed. In addition to restricting how much a person can eat, the surgery reduces hunger and the desire to overeat by eliminating the portion of the stomach that produces ghrelin, the hormone that stimulates appetite.

Both sleeve gastrectomy and gastric bypass, as well as other albeit less effective bariatric approaches, can be done laparoscopically, with patients spending only a day or two in the hospital.