Appetite suppressants are agents that promote weight loss by decreasing appetite or increasing the sensation of fullness. About one-quarter of the U.S. population can be considered obese (BMI of >20). Four million of these people may be classified as morbidly obese (BMI of >40). Obesity is associated with increased risk of hypertension, type 2 diabetes and heart disease.
The use of appetite suppressant medications to treat obesity in combination with physical activity and diet modification is often recommended to lose and maintain weight successfully over the long term.
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gastric bypass surgery background
Roux-en-Y gastric bypass surgery is the most common weight loss surgery which uses staples to restrict food intake. The staples are surgically placed near the top of the stomach to section off a small portion that is often called a stomach pouch. Then, 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), and the first portion of the jejunum (the second segment of the small intestine). Because part of the digestive system is "bypassed", absorption of food and nutrients is decreased.
This surgery is often performed in those who have a
BMI ≥40 (extremely obese) or BMI between 35 to 39.9 and with weight-related health problems, such as diabetes or high blood pressure.
Surgical candidates go through an extensive screening process. Not everyone who meets the criteria for the surgery is psychologically or medically ready for the surgical procedure. A team of professionals, including a physician, dietitian, psychologist and surgeon, evaluate whether the surgery is appropriate. Following surgery, physical, nutritional and metabolic counseling are given to prevent nutritional deficiencies. Lifelong use of nutritional supplements such as multivitamins, vitamin B12, vitamin D and calcium is recommended.
Researchers have found greater weight loss in gastric bypass (an average of 93.3 pounds) compared to gastroplasty ( an average of 67 pounds) after one year. Over two years, gastric bypass surgery patients have been shown to lose two-thirds of excess weight. The success rate for weight loss for Roux-en-Y gastric bypass surgery is 68 to 72% of excess body weight over a three-year period, and 75% for biliopancreatic diversion. After five years, the average excess weight loss from gastric bypass surgery ranges from 48 to 74%.
The improvements observed in type 2 diabetes, high blood pressure and high blood cholesterol may significantly decrease the risk of cardiovascular events in individuals who have undergone gastric bypass surgery compared with those treated through other means. Gastric bypass surgery has also shown to improve mobility and quality of life for people who are severely overweight.
risks of gastric bypass surgery
A risk of death has been associated with gastric bypass surgery. The risk varies depending on age, general health and other medical conditions. Patients should review the risks of gastric bypass surgery with a doctor.
Blood clots in the legs are more likely to occur in very overweight people. Blood clots can be dangerous. In some cases, they travel to the lungs and lodge in the lungs' arteries, causing a pulmonary embolism - a serious condition that damages lung tissue and can lead to death. Walking and using leg wraps that apply intermittent pressure to the leg can help reduce this risk of blood clots in the legs.
Leaking of the stomach contents into the body cavity at a staple line has occurred and can be treated with antibiotics. Most cases heal with time. Sometimes, the leak can be serious enough to require emergency surgery.
Excess weight places extra stress on the chest cavity and lungs. This means a higher risk of developing pneumonia after the surgery.
Narrowing of the opening between the stomach and small intestine has occurred. This rare complication may require either an outpatient procedure to pass a tube through the patient's mouth to widen (dilate) the narrowed opening or corrective surgery.
Gastric bypass can also cause dumping syndrome, a condition where stomach contents move too quickly through the small intestine causing nausea, vomiting, diarrhea, dizziness and sweating.
Other common complications include vitamin and mineral deficiency, dehydration, gallstones, bleeding stomach ulcer, hernia at the incision site and intolerance to certain foods.
other types of weight loss surgery
Adjustable gastric banding: The surgeon uses an inflatable band to partition the stomach into two parts. The surgeon then wraps the band around the upper part of the stomach and pulls it tight, like a belt, creating a tiny channel between the two pouches. The band keeps the opening from expanding and is designed to stay in place indefinitely, but it can be adjusted or surgically removed if necessary. Most surgeons perform this operation using a laparoscope.
Biliopancreatic diversion: In this procedure, a portion of the stomach is removed. The remaining pouch is connected directly to the small intestine, but completely bypasses the duodenum and jejunum where most nutrient absorption takes place. This weight-loss surgery offers sustained weight loss, but it presents a greater risk of malnutrition and vitamin deficiencies and requires close monitoring.
Jaw wiring: This is a form of food intake restriction for temporary use in patients without respiratory problems. It can be effective for short-term weight loss. However, weight regain occurs soon after the wires are removed.
Liposuction: This is the most frequent cosmetic operation in the United States in which fat tissue is removed. Relatively small amounts of total body fat can be removed safely, however, and little weight is lost.
Vertical banded gastroplasty: This operation divides the stomach into two parts - limiting space for food and forcing the patient to eat less. There is no bypass. Using a surgical stapler, the surgeon divides the stomach into upper and lower sections. The upper pouch is small and empties into the lower pouch - the rest of the stomach. Partly because it doesn't lead to adequate long-term weight loss, surgeons use it less commonly than gastric bypass.