Summary: Surgery for weight management may be appropriate for those who have tried and not been successful with a prior program. Surgery should not replace the three mainstays of weight management --- behavioral or lifestyle changes, exercise and decreased caloric intake. For now, surgery is not usually considered as “front line’ by most weight management professionals. There are different surgeries that are classified into one of two types: surgeries that decrease the size of the stomach and surgeries that create an inability for the body to absorb calories (but also other potentially essential elements such as vitamins). Surgeries are becoming more common, but long term maintenance of decreased weight still requires behavioral changes in eating as well as exercise. Restrictive procedures to decrease the size of the stomach decreases your desire to eat and your ability to eat; a common surgery is a “sleeve” gastrectomy. There are risks from any of these surgeries including mortality (but that risk is probably less than 0.5% even with the more complicated procedures). Infection and leakage of fluid into the abdomen from within the stomach) are also risks of surgery. The risks go down dramatically among the surgeons who do a lot of these procedures. The least invasive procedures may work for those who are not extremely obese, and depending upon other illnesses, these procedures may be done without a hospital stay. That is a decision between patient and physician. For any of these surgeries, the need to walk before and after surgery is very valuable to help maintain good breathing and prevent clots in the legs. For information about the procedures, a good web site is www.obesityhelp.com. Internet sites can also help with lifestyle change programs; the National Institutes of Health’s web sites are a good place to start.
