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The original food pyramid, with four food groups, has been replaced with an updated food guide called "My Pyramid." This illustrates the relative proportions of different foods that make up a nutritious, well-balanced diet and includes exercise.
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Calorie Restriction
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Calorie restriction has been the cornerstone of obesity treatment. The standard dietary recommendations for losing weight are as follows:
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\r\n- As a rough rule of thumb, one pound of body fat is the result of eating about 3,500 calories. A person could lose a pound a week by reducing daily caloric intake by about 500 calories a day. Naturally, the more severe the daily calorie restriction, the faster the weight loss. Very-low calorie diets have also been associated with better success, but extreme diets can have some serious health consequences.
\r\n- To determine your daily calories requirements, multiply the number of pounds of ideal weight by 12 - 15 calories. The number of calories per pound depends on gender, age, and activity levels. For instance, a 50-year old woman who wants to maintain a weight of 135 pounds and is mildly active might require only 12 calories per pound (1,620 calories a day). A 25-year old female athlete who wants to maintain the same weight might need 25 calories per pound 2,025 (calories a day).
\r\n- Fat intake should be no more than 30% of total calories. Most fats should be in the form of monounsaturated fats (such as olive oil). Saturated fats (found in animal products) should be avoided.
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Warning on Extreme Diets
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Extreme diets of fewer than 1,100 calories carry health risks. They are also often followed by bingeing or overeating, and a return to obesity. Such diets often do not have enough vitamins and minerals, which must then be taken as supplements. Most of the initial weight loss is in fluids. Later, fat is lost, but so is muscle, which can account for more than 30% of the weight loss. No one should be on very strict diets for longer than 16 weeks, or fast for weight loss. Severe dieting has unpleasant side effects, including fatigue, intolerance to cold, hair loss, gallstone formation, and menstrual irregularities. There have been rare reports of death from heart arrhythmias when liquid formulas did not have sufficient nutrients. Pregnant women who excessively diet during the first trimester put their unborn children at risk for birth defects. Of note, those whose diets include a high intake of fluids and much reduced protein and sodium are at risk for hyponatremia, which can cause fatigue, confusion, dizziness, and in extreme cases, coma and death.
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Low-Fat and High-Fiber Diets
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This dietary approach requires counting only grams of fat with the goal of achieving 30% or fewer calories from fat. One gram of fat contains nine calories, while one gram of carbohydrates or protein has only four calories. Fat in your diet converts more readily to fat in the body, compared with carbohydrates or proteins. Simply switching to low-fat or skimmed dairy products may be enough for some people.
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There are possible drawbacks to this approach:
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\r\n- Some people who reduce their fat intake severely may not get enough basic nutrients, including vitamins A and E, folic acid, calcium, iron, and zinc. People on low-fat diets should eat a wide variety of foods and take a multivitamin supplement, if appropriate. Calcium deficiencies may be particularly harmful in women at risk for osteoporosis.
\r\n- Many people start eating foods with too many carbohydrates, believing that they are not adding calories. No one should use a low-fat diet as an excuse for eating too many carbohydrates, particularly starchy foods and sugar. A high-calorie diet from any source will add pounds.
\r\n- Replacing fatty foods, such as cakes, cookies, and chips, with their commercial "low-fat" counterparts does not constitute a low-fat diet. These foods generally contain more sugar and hence calories, not to mention other ingredients, which have virtually no nutritional value.
\r\n- Very low-fat diets may increase the risk for stroke from hemorrhage in the brain.
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Some fat in a diet is essential. It should come from plant oils and fish, however, and not from animal products or hardened oils, such as margarine. Trans fatty acids, found in hardened oils, are actually more of a risk factor for obesity than saturated fats from animal products, although both should be avoided.
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Fiber and Complex Carbohydrates. In all cases, complex carbohydrates found in whole grains and vegetables are preferred over those found in starch-heavy foods, such as pastas, white-flour products, and potatoes. Fiber is an important component of many complex carbohydrates. Fiber is found only in plants, particularly vegetables, fruits, whole grains, nuts, and legumes (beans and peas). One exception is chitosan, a dietary fiber made from shellfish skeletons. Fiber cannot be digested but passes through the intestines, drawing water with it, and is eliminated as part of feces content. The following are specific advantages from high-fiber diets (up to 55 grams a day):
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\r\n- Insoluble fiber (found in wheat bran, whole grains, seeds, nuts, and fruit and vegetable peels) has been associated with weight loss. Studies also suggest that diets rich in fiber from whole grains reduce the risk for type 2 diabetes.
\r\n- Soluble fiber (found in dried beans, oat bran, barley, apples, citrus fruits, and potatoes) has important benefits for the heart, particularly for achieving healthy cholesterol levels and possibly benefiting blood pressure as well. Simply adding breakfast cereal to a diet appears to reduce cholesterol levels. People who increase their levels of soluble fiber should also increase water and fluid intake.
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Low-Carbohydrate Diets
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Low carbohydrate diets generally restrict the amount of carbohydrates but do not restrict protein sources.
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The Atkins diet restricts complex carbohydrates in vegetables and, particularly, fruits that are known to protect against heart disease. The Atkins diet can also cause excessive calcium excretion in the urine, which increases the risk for kidney stones and osteoporosis.
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"Low-Carb" diets, such as South Beach, The Zone, and Sugar Busters, rely on a concept called the "glycemic index," or GI, which ranks foods by how fast and how high they cause blood sugar levels to rise. Foods on the lowest end of the index take longer to digest. Slow digestion wards off hunger pains. It also helps stabilize insulin levels. Foods high on the glycemic index include bread, white potatoes, and pasta, while low-glycemic foods include whole grains, fruit, lentils, and soybeans.
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There has been debate about whether Atkins and other low-carbohydrate diets can increase the risk for heart disease, as people who follow these diets tend to eat more animal-saturated fat and protein and less fruits and vegetables. In general, these diets appear to lower triglyceride levels and raise HDL ("good") cholesterol levels. Total cholesterol and LDL ("bad") cholesterol levels tend to remain stable or possibly increase somewhat. However, large studies have not found an increased risk for heart disease, at least in the short term. In fact, some studies indicate that these diets may help lower blood pressure.
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Low-carbohydrate diets help with weight loss in the short term, possibly better than diets that allow normal amounts of carbohydrates and restrict fats. However, overall, there is not good evidence showing long-term efficacy for these diets. Likewise, long-term safety and other possible health effects are still a concern, especially since these diets restrict healthy foods such as fruit, vegetables, and grains while not restricting saturated fats.
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Fat and Sugar Substitutes
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Replacing fats and sugars with substitutes may help many people who have trouble maintaining weight.
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Fat Substitutes. Fat substitutes added to commercial foods or used in baking deliver some of the desirable qualities of fat, but they do not add as many calories. They cannot be eaten in unlimited amounts, however, and are considered most useful for helping keep down total calorie count.
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Olestra (Olean) passes through the body without leaving behind any calories from fat. Studies suggest that it helps improve cholesterol levels and may help overweight people lose weight. Early reports of cramps and diarrhea after eating food containing olestra have not proven to be significant. Of greater concern is the fact that even small amounts of olestra deplete the body of certain vitamins and nutrients that may help protect against serious diseases, including cancer. The FDA requires that the missing vitamins, but not other nutrients, be added back to olestra products.
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Beta-glucan is a soluble fiber found in oats and barley. Products using this substance (Nu-Trim) may reduce cholesterol and have additional health benefits.
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A number of other fat-replacers are also available. Although studies to date have not shown any significant adverse health effects, their effect on weight control is uncertain, since many of the products containing them may be high in sugar. People who learn to cook using foods naturally lacking or low in fat eventually lose their taste for high-fat diets, something that may not be true for those using fat substitutes.
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Artificial Sweeteners. Many artificial or low-calories sweeteners are available. A 2002 study confirmed that people who consumed artificial sweeteners and reduced their sugar intake weighed less over time than those who took in similar types and amounts of drinks and food containing sugar. It should be noted that using these artificial sweeteners should not give dieters a license to increase their fat intake. Studies indicate that consuming some sugar is not a significant contributor to weight gain, as long as the total amount of calories in the diet is under control. There is some public concern about chemicals used to produce many of these sweeteners, and the side effects seen in studies using rats. Natural low-calories sweeteners are available that may be more acceptable to many people.
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\r\n- Saccharin (Sugar Twin, Sweet\'N Low, Sucaryl, and Featherweight). Saccharin has been used for years. Some studies found that large amounts of saccharin cause bladder cancer in rats. However, the rats were fed huge amounts that do not apply to human diets. Currently there is no evidence that saccharin causes cancer in humans.
\r\n- Aspartame (Nutra-Sweet, Equal, and NutraTase). Aspartame has come under scrutiny because of rare reports of nervous system disorders, including headaches or dizziness, associated with its use. People with phenylketonuria (PKU), a genetic condition, should not use it. Studies have not reported any serious health dangers in otherwise healthy individuals, but some people may be sensitive to aspartame.
\r\n- Sucralose (Splenda). Sucralose has no bitter aftertaste and works well in baking, unlike other artificial sweeteners. It is made from real sugar by replacing part of the sugar with chlorine. Some people are concerned because chlorinated molecules used in major industrial chemicals have been associated with cancer and birth defects. Over 100 studies have been conducted on sucralose over a 20-year period, with no reports of such risks.
\r\n- Acesulfame-potassium (Sweet One, SwissSweet, and Sunette). It has been used in the U.S. since 1988 with no reported side effects.
\r\n- Neotame (Neotame). Neotame is a synthetic variation of aspartame, developed to avoid its side effects. The association with aspartame has raised some concerns. Studies to date have reported no effects that would cause alarm, and it appears to be safe for general consumption.
\r\n- D-tagatose (Tagatose). This reduced-calorie sweetener is made from lactose, which is the sugar found in dairy products and other foods. It may be especially beneficial for people with type 2 diabetes. It may also have additional benefits that help the intestinal tract.
\r\n- Alitame (Aclame) is formed from amino acids, the building blocks of proteins. It has the potential to be used in all products that contain sugar, including baked goods.
\r\n- Stevioside (Stevia). This is a natural sweetener derived from a South American plant. It is available in health food stores. People with diabetes should avoid alcohol-based forms. It has not been carefully tested.
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Other sugar substitutes being investigated include glycyrrhizin (derived from licorice) and dihycrochalcone (derived from citrus fruits).
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Liquid Meal Replacements
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Some studies have reported good success with meal replacement beverages (such as Slim-Fast and Sweet Success). They contain major nutrients needed for daily requirements. Each serving typically contains 200 - 250 calories and replaces one meal. (Note: Using them for all meals reduces calories to a severe extent and can be harmful.)
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One study reported that most subjects who had undergone a 12-week weight loss program followed by using Ultra Slim Fast supplements as directed for maintenance kept off more than half their weight loss after more than 3 years. A quarter of the subjects were still losing weight.
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Magnesium and Diet
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Some evidence suggests that a diet rich in magnesium could reduce a person\'s risk of metabolic syndrome, a cluster of problems that include obesity, high blood pressure, and high cholesterol. Metabolic syndrome can lead to diabetes and heart disease. Epidemiological studies have found that the risk for metabolic syndrome decreases in those who consume the highest amounts of magnesium from meals.
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Medications
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There are several different drugs used for weight loss. Unless specifically instructed by a doctor, people should use non-drug methods for losing weight. Except under rare circumstances, pregnant or nursing women should never take diet medications of any sort, including herbal and over-the-counter remedies. While weight loss drugs in general have shown some benefit, the overall weight loss achieved is generally limited. In addition, people will usually regain the weight when they discontinue the medication.
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Over-the-Counter Weight Loss Products and Herbal Remedies
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About 7% of American adults use nonprescription weight-loss products. People must be cautious when using any weight-loss medications, including over-the counter diet pills and herbal remedies. Buying unverified products over the Internet can be particularly dangerous.
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Green Tea. Some studies have suggested that regular tea drinking is associated with lower weight, particularly in people who drink it for years. However, better evidence is needed to confirm the results on this supplement.
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Thermogenic Approach to Weight Loss. An approach to weight loss called thermogenic (or hepatothermic) therapy is based on the claim that certain natural compounds have properties that enable the liver to increase energy in cells and stimulate metabolism. Theoretically, the result would be fat loss. Among the substances used in such products are EPA-rich fish oil, sesamin, hydroxycitrate, pantethine, L-carnitine, pyruvate, aloe vera, aspartate, chromium, coenzyme Q10, green tea polyphenols, aloe vera, DHEA derivatives, cilostazol, diazoxide, and fibrate drugs.
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Nearly all the current over-the-counter dietary aids contain some combination of these ingredients. There is no evidence that any of these ingredients can produce weight loss, and some may even have harmful effects.
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Chromium is a common ingredient in many diet supplements (such as Xenadrine, Dexatrim, Acutrim Natural, and Twinlab Diet Fuel). It is claimed to specifically promote fat loss, rather than lean muscle loss. Some evidence suggests that niacin-bound chromium may improve insulin sensitivity. On the negative side, animal studies have suggested that chromium may have damaging effects on genetic materials in cells. This could cause sterility.
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Warnings on Some Ingredients in Over-the-Counter Diet Products
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Ephedra, Ephedrine, and Ma Huang. The FDA does not allow the sale of drugs that contain ephedrine. In May 2004, the FDA banned the sale of dietary supplements that contain ephedra (also called Ma Huang). Ephedra can cause serious side effects, including strokes and heart attacks.
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Brazilian Diet Pill. The FDA has warned consumers not to buy a product known as the "Brazilian diet pill." This product is labeled as a dietary supplement, but contains several chemicals found in powerful prescription drugs. The products are also known as Emagrece Sim and Herbathin dietary supplements.
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Conjugated Linoleic Acid (CLA). Conjugated linoleic acid is found in many dietary products (such as Biosculpt Liquid, Body Success, and GNC Optibolic Body Answers Dietary Formula). There is no evidence that it produces weight loss. Furthermore, there is some concern that CLA might increase insulin resistance and a dangerous inflammatory response in people with obesity.
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Tiratricol. Over-the-counter products containing tiratricol, a thyroid hormone, have been sold for weight loss. Such products may increase the risk for thyroid disorders, heart attack, and stroke. Tiratricol is also known as triiodothyroacetic acid or TRIAC.
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Laxative Actions in Natural Substances. Many dietary herbal teas contain laxatives, which can cause gastrointestinal distress, and, if overused, may lead to chronic pain, constipation, and dependency. Rarely, dehydration and death have occurred. Some laxative substances found in teas include senna, aloe, buckthorn, rhubarb root, cascara, and castor oil.
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Guar Gum. Some fiber supplements containing guar gum have also caused obstruction of the esophagus and gastrointestinal (digestive) tract.
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Chitosan. Chitosan, a dietary fiber from shellfish, prevents a small amount of fat from being absorbed in the intestine. Well-conducted studies, however, have not found it to be effective. Products containing it include Natrol, Chroma Slim, and Enforma. People who are allergic to shellfish should not take these supplements.
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Plantain. Dietary remedies that list the ingredient plantain may contain digitalis, a powerful chemical that affects the heart. NOTE: This substance should not be confused with the harmless banana-like plant also called plantain.
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Orlistat (Xenical)
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Orlistat (Xenical) can help about one-third of obese patients with modest weight loss and can help in long-term maintenance of weight loss. It works by slowing the absorption of fat in the intestine (by about 30%). The average weight-loss attained is around 6 lbs. with use of this drug. However, many people regain a significant portion of this weight within 2 years. While it does not work for all patients, orlistat may delay or even prevent the onset or progression of diabetes, and improve cholesterol levels, regardless of weight loss.
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Orlistat can cause gastrointestinal problems and may interfere with absorption of the fat-soluble vitamins A, D, and E and other important nutrients. The most unpleasant side effect is leakage of oily feces from the anus. Restricting fats can reduce this effect. People with bowel disease should probably avoid it. In spite of these side effects, most patients are able to tolerate this agent.
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In February 2007, the FDA approved an over-the-counter version of orlistat. Sold under the name alli, it is available at half the prescription strength of Xenical. Those eager to use the new pill should consider its cost (around $100 per month) and modest benefits compared with its side effects, most commonly oily diarrhea.
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Note: This pill, which prevents fat absorption from food, also increases the risk of not absorbing important nutrients from food while using it. The FDA recommends taking a daily multivitamin supplement when using alli.
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Sibutramine (Meridia)
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Sibutramine (Meridia) helps balance the brain chemicals serotonin and norepinephrine. This helps increase metabolism, causes a feeling of fullness, and increases energy levels. It may be particularly useful for binge-eaters. Studies indicate that sibutramine is effective in achieving weight loss, although the weight loss slows considerably after the first 3 months. The average one-year weight-loss using this drug is around 9 lbs. The drug also appears to improve cholesterol and lipid (fat) levels, and it may have other effects that benefit the heart.
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Side effects of sibutramine are common. They include dry mouth, constipation, and insomnia. Many patients discontinue the drug as a result of these side effects. There have been reports of increases in heart rate and blood pressure while taking this medication.
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At this time, people who have a history of high blood pressure, stroke, heart disease, or arrhythmias should not take this drug. People taking decongestants, bronchodilators (such as for asthma), monoamine oxidase inhibitors, or serotonin reuptake inhibitors should also avoid sibutramine.
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Psychostimulants
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Phentermine and Other Sympathomimetics. Sympathomimetics are drugs that act like the stress hormone (and chemical messenger) norepinephrine. These medications act as stimulants in the brain. Some are approved for treating obesity, but only for short-term use of 12 weeks or less. Average weight-loss has been in the range of 7 lbs. over the short-term. These medicines include:
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\r\n- Phentermine (Ionamin, Adipex-P, Fastin)
\r\n- Benzphetamine (Didrex)
\r\n- Phendimetrazine (such as Adipost, Bontril, Melfiat, Plegine, Prelu-2, and Statobex)
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Phentermine is the most commonly prescribed appetite suppressant, and is less expensive than orlistat or sibutramine. Its effects are not long lasting, however. It can also raise blood pressure. In addition, phentermine is associated with depression, which is already a problem in many cases of obesity. A combination (Phen-Pro) containing phentermine and the antidepressant fluoxetine (Prozac) is being investigated to help reduce this problem. Note: Neither phentermine nor such combinations are associated with the heart problems linked to the previous phentermine combination known as Fen-Phen (phentermine and fenfluramine).
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Amphetamines. The amphetamines dextroamphetamine (Dexedrine), methamphetamine (Desoxyn), and phenmetrazine (Pleudin) are powerful stimulants. They were used most often in the past but are no longer prescribed for weight loss. These drugs improve mood and produce some modest weight loss over the short term, but carry serious risks of addiction, agitation, and insomnia.
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Investigative Drugs
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Rimonabant. Rimonabant (Accompli) belongs to a new class of drugs called selective CB1 blockers. The drug is designed to block receptors in the brain associated with the regulation of eating. Rimonabant also targets receptors in fat tissue.
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Studies involving the drug reported that obese patients treated with 20 mg of rimonabant lost significantly more weight and inches from their waist than patients who received placebo. The drug also appeared to have beneficial effects on raising HDL ("good") cholesterol levels. However, in April 2007 an FDA advisory panel rejected the drug, citing fears it may cause psychiatric problems and seizures in some patients.
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Note: Fake rimonabant has been found for sale on several web sites and in several supposedly "natural" weight loss products. Patients should be aware that this drug is still experimental, and rimonabant is not available for sale. Buying and taking counterfeit drugs can have serious health consequences.
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Topiramate. Topiramate (Topamax) is an anti-seizure medication being investigated for weight reduction. Several clinical trials have reported that obese patients with type 2 diabetes given topiramate lost more weight than those receiving placebo. Weight loss was sustained for up to 1 year. The drug is also being studied for binge-eating disorders associated with obesity. However, psychiatric and neurological side effects may prevent topiramate from being used regularly.
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Cellulite Treatment
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Cellulite-Removal Creams. Many women try to reduce fat in their thighs (cellulite) with creams that contain aminophylline (such as Skinny Dip, Thermojetics Body Toning Cream, and Smooth Contours). Studies provide no evidence that these creams are effective. Their apparent effect on fat may simply be from narrowing blood vessels and forcing water from the skin, which could be dangerous for people with blood flow problems.
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Endermologie. Endermologie uses motorized rollers and regulated suction to smooth out cellulite.
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Surgery
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Surgical procedures for obesity may be appropriate for some dangerously obese people, and they may reduce heart problems and many of the risks associated with obesity. These risks include high blood pressure, sleep apnea, and diabetes. In fact, some evidence suggests that surgery may provide much greater control of weight and diabetes than nonsurgical weight-loss methods. Studies are reporting significant reductions in diabetes, and the need for diabetic medications, after surgery. Other medical conditions that often improve after surgery include heartburn, arthritis, and other joint and circulation problems.
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The care of patients undergoing bariatric surgery, before and after surgery, requires specialized expertise and facilities. Studies have shown that the likelihood of complications is significantly associated with the experience of the surgeon and staff.
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Bariatric surgeries produce weight loss through one of two approaches:
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\r\n- Restrictive Banding Procedures. These procedures restrict the amount of food by closing off parts of the stomach with bands.
\r\n- Malabsorptive Bypass Procedures. This approach restricts the amount of food and also reduces absorption by using a bypass of parts of the intestine.
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The malabsorptive procedures are more successful in achieving weight loss than the banding approach, but they carry a greater risk for nutritional deficiencies.
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Benefits of Bariatric Surgery
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Most people who have bariatric surgery lose about two-thirds of excess weight within 2 years. In addition, diseases associated with obesity (such as diabetes, high blood pressure, sleep apnea, joint pain, and incontinence) often improve.
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A number of studies have been published showing that bariatric surgery leads to improved control of diabetes and hypertension.
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Other studies have shown that even though most patients maintain significant weight loss, the majority regain about 10% of their weight. Patients must still develop a healthy lifestyle and be calorie conscious after the operation. Follow-up must be lifelong.
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Candidates for Bariatric Surgery
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Any surgical candidate must have failed consistently in losing weight through less invasive methods. Experts recommend bariatric surgery only for the following:
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\r\n- Those whose BMI is above 40 (about 100 pounds overweight)
\r\n- Those with a BMI of over 35 who have type 2 diabetes or serious obesity-related medical problems
\r\n- Those with severe obesity that interferes with employment, normal physical activity (such as walking), and important relationships
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Patients with binge eating disorder should be identified before surgery and treated. A full evaluation, including a psychological evaluation, should be performed on all candidates for surgery.
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Depending on insurance coverage and which procedure is performed, the cost of bariatric surgery may be up to $35,000
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Patient considering bariatric surgery should be well-informed regarding the procedure, its efficacy, side effects, and complications. They should also understand the following:
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\r\n- Lifestyle and behavioral changes will still be needed after surgery, including:\r\n
\r\n- The continued need to focus on weight
\r\n- The need to chew food well
\r\n- The need for dietary restrictions
\r\n- The need for vitamin and mineral supplementation
\r\n- Patients will be unable to eat large meals.
\r\n- Surgery may not be successful in achieving significant weight loss.
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Restrictive Banding Procedures
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About a third of people who undergo these procedures achieve normal weight, and 80% experience some weigh loss. They are less successful than the bypass procedures, but carry a lower risk of nutritional deficiencies.
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Laparoscopic Gastric Banding. Laparoscopic gastric banding (the Lap-Band) usually does not require a major incision and avoids some of the major complications of gastric bypass. Patients lose almost one third to one half of their excess weight after this procedure. Some smaller trials have shown remission of type 2 diabetes in over 70% of patients having the surgery, compared to around 10% treated medically. Death during or after the surgery occurs in fewer than 1/1000 of these procedures.
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The Lap-Band procedure restricts the amount of food a person can eat and gives the feeling of fullness. It employs an adjustable silicone band that is placed around the upper part of the stomach. A small balloon-like reservoir attached to the band under the abdominal skin contains saline, which can be added or removed to tighten or loosen the band.
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The band is removable, if necessary. Studies to date indicate that the intestinal tract returns to normal afterward. Studies, including those done in the elderly, have reported significant weight loss and improved quality of life with the procedure.
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Malabsorptive Bypass Procedures
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Malabsorptive procedures produce greater weight loss than restrictive procedures. Patients generally achieve about two-thirds of their weight loss within 2 years. Furthermore, in a 2003 study, after standard bypass surgery, 83% of patients with type 2 diabetes had normal blood glucose levels, and the rest had significant weight reductions.
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Roux-en-Y Gastric Bypass Procedure. This is the most common and successful malabsorptive surgery in the United States. It involves creating a small stomach pouch that serves as a reservoir and restricts food intake. The pouch eventually holds up to 3 ounces of food and has a small outlet that delays emptying and causes a feeling of fullness. Then the surgeon creates a Y-shaped section in the small intestine that attaches to the pouch. This section allows food to bypass the lower stomach and upper part of the intestine.
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Patients on average lose about 60% of their excess weight. Studies have shown improvements in control of type 2 diabetes and reduction in blood pressure. The procedure produces greater and more sustained weight loss than banding procedures, but it is also more complicated. Laparoscopy techniques, which are less invasive, are now preferred over open surgery. They achieve equally good results with fewer complications. Death during or after the surgery occurs in five out of 1000 patients having this procedure.
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By definition, these procedures bypass the first part of the small intestine and carry poorly digested food to a part of the intestine that cannot absorb it as easily. Some patients develop what is called dumping syndrome. Symptoms include nausea, vomiting, bloating, cramping, diarrhea, sweatiness, dizziness, and fatigue. These problems occur anywhere from immediately after eating to 3 hours afterwards. Patients with this problem carry a higher risk of nutritional deficiencies..
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Side Effects and Complications
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General Side Effects and Complications. Side effects and complications of bariatric procedures are common, and up to 25% of patients need corrective or repeat procedures. After any of these procedures people must chew all their food carefully, and they cannot eat large amounts of food at one time. If patients do not follow these guidelines, they will experience nausea, abdominal distress, or both.
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Complications from any bariatric procedure include:
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\r\n- Vomiting: This is the most common complication, and it is most common with banding procedures. It is generally a result of eating more than the reduced stomach size can hold. With laparoscopic banding, adjustment of pouch size can be performed relatively easily.
\r\n- Heartburn, gastritis, and problems swallowing
\r\n- Nutritional deficiencies: There is a strong risk of nutritional deficiencies, particularly with malabsorptive operations. This complication can lead to anemia, due to either iron or vitamin B12 deficiencies. Nutritional deficiencies can also increase the risk of bone loss and osteoporosis, due to calcium deficiency. Taking enough mineral and vitamin supplements is important after bariatric surgery.
\r\n- Deep-vein thrombosis: There is a significant risk for deep-vein thrombosis (blood clots in the veins).
\r\n- Abdominal hernia: This is another common complication. Newer, laparoscopic techniques do not carry this risk, but not all individuals are candidates for this less-invasive approach.
\r\n- The stomach pouch can break down over time and need repair.
\r\n- Rapid weight loss after surgery: This complication puts people at high risk for gallstones.
\r\n- Women who wish to be pregnant should wait until their weight has stabilized. Rapid weight loss and nutritional deficiencies can harm the fetus.
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People at highest risk for complications are those with heart or lung problems, severe obesity, and a history of abdominal surgeries. The mortality rate from bariatric surgeries is 0.2%, which is lower than the morality rates from severe obesity itself.
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Specific Complications of Restrictive Banding Procedures. Nausea, vomiting, or both occurs in half of patients, and severe heartburn occurs in a third. Device-related complications include band slippage, pouch dilation (widening), or both in nearly a quarter of patients, and obstruction in 12% of patients. Very serious complications are rare, but they can include blood clots, bleeding, infection, pneumonia, and perforation (tearing) of the stomach.
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Specific Complications of Malabsorptive Bypass Procedures. Vomiting often occurs. Nutritional deficiencies occur more often in these procedures.
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Care after Bariatric Procedures
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Most people stay in the hospital for a few days after gastric bypass surgery. Patients are discharged when they can:
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\r\n- Eat liquid or pureed food without vomiting
\r\n- Move without too much discomfort
\r\n- No longer need pain medication given by injection
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Patients continue to eat a liquid or soft diet for several weeks after the surgery. In patients receiving a pouch procedure, the pouch eventually expands to about one cup of chewed food (a normal stomach can hold up to one quart).
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Follow-up appointments are essential to determine if nutritional supplements, such as iron, calcium, vitamin B12, or other nutrients, are needed. Supplements, such as a multivitamin with minerals, may be prescribed.
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Patients should eat small meals (usually six) throughout the day, rather than large meals that the stomach can no longer handle.
\r\n
The new stomach probably won\'t be able to handle both solid food and fluids at the same time. Patients should separate fluid and food intake by at least 30 minutes and only sip what they are drinking.
\r\n
After surgery, tolerance of fat, alcohol, or sugar decreases. Patients should reduce their fat intake, especially:
\r\n
\r\n- Deep-fried foods
\r\n- Fast-food meals
\r\n- High-fat foods
\r\n- High-sugar foods, such as cakes, cookies, and candy
\r\n
Exercise and the support of others (for example, joining a support group with people who have undergone weight-loss surgery) are extremely important in achieving and maintaining weight loss after bariatric surgery.
\r\n
Exercising can usually resume 6 weeks after the operation. Even sooner than that, most patients will be able to take short walks at a comfortable pace, after consulting with their doctor.
\r\n
Liposuction
\r\n
Liposuction eliminates fat in specific areas, such as the abdomen, thighs, buttocks, or knees. Special instruments are inserted through the skin into the pockets, and suction is used to move the fat, break it up, and remove it. Small tubes may be used to drain blood and fluid during the first few days. The pain after the operation can be severe, and often the skin does not contract, resulting in a flabby look. Complications can include burns from the vibrators, bruising, blood clots, and bleeding. Weight gain generally tends to develop in other locations after the operation.
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