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Obesity surgeries and how they work

Weight-loss surgery such as the type that New Jersey Gov. Chris Christie had recently may not just improve people's waistlines, but their health.

Obesity causes or worsens myriad health problems, from diabetes to heart disease, severe sleep apnea to arthritic knees. Christie has revealed that after struggling with his weight for 20 years and by the reality of turning 50 years old, the desire to be healthy for his four children motivated him to have an operation called stomach banding.

"He's doing the right thing," said Dr. Jaime Ponce, president of the American Society for Metabolic & Bariatric Surgery. "He's at the age he really needs to address his problem, to live longer, in a better way, with a better quality of life."

Specialists perform about 160,000 weight-loss operations a year in the United States, according to a recent analysis by the surgeons' group. Surgery isn't a panacea, it isn't for everyone -- and some forms work better than others.

Some questions and answers about the different types:


What is the most common weight-loss surgery?

In the United States, it's gastric bypass, sometimes called stomach-stapling. It generally results in the most weight loss. Doctors wall off part of the stomach so that it can hold only a small amount of food. In addition, they reroute that food past part of the intestine so the body absorbs fewer calories.

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How is stomach banding different?

It's a less invasive operation, and, unlike gastric bypass, it's reversible -- the band can be removed if necessary. Best known by the brand name Lap-Band, an adjustable band is placed around the stomach to restrict how much food someone can eat at one time. As weight is lost, the band can be tightened. Typically, patients don't lose as much as with gastric bypass.


Are there other options?

The third major approach is called a gastric sleeve, which removes a large chunk of the stomach and thus cuts production of one of the body's hunger-stimulating hormones. Another, less-used option, is a complex operation called a duodenal switch, which also involves rerouting food.


How effective?

Over a year or two, weight-loss surgery can lead to loss of 50 percent to even 80 percent of the person's excess weight -- if he or she sticks with a healthy diet and exercise. More important, research shows weight-loss surgeries can reverse Type 2 diabetes in patients who lose enough weight and keep it off. Gastric bypass causes the fastest weight loss, and stomach banding is more gradual.

But patients don't always benefit enough to justify surgery. The Agency for Healthcare Research and Quality cited reports that within five years, up to a third of stomach-banding patients aren't maintaining their weight loss.

"You don't want somebody to always drink milkshakes because they're going to defeat the surgery over time," Ponce said.


Is surgery safe?

Most are done laparoscopically -- through small incisions -- and Ponce's group says the risk of death is lower than for operations to remove a gallbladder or replace a hip. However, patients may suffer from infection, blood clots, and broken or leaking stitches or staples.

After surgery, side effects can include vitamin deficiencies because food is digested differently. In addition, people initially have to learn to eat less and chew well to avoid vomiting. Gastric bypass patients also may suffer a complication that causes cramping and diarrhea, especially after eating sweets. The gastric band may slip out of place.


Who's a candidate?

Generally, someone who is about 100 pounds overweight and has failed at other attempts to lose. Doctors evaluate body mass index, a measure of body fat based on height and weight. Candidates have a BMI of at least 40, or a BMI of 35 along with a weight-related health problem. For example, someone who is 5-foot-10-inches and weighs 279 pounds has a BMI of 40.

In 2011, The Food and Drug Administration relaxed the rules for stomach-banding, allowing it for patients with a BMI as low as 30 who have a weight-related medical condition.

Weight-loss surgery can cost anywhere from $14,000 to $20,000; insurance tends to cover it for people who are sicker and more obese.

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