Obesity results from the excessive accumulation of fat that exceeds the body’s skeletal and physical standards. Morbid obesity is a serious disease process in which the accumulation of fatty tissue on the body becomes excessive and interferes with or injures the other bodily organs. This can cause serious and life-threatening health problems, which are known as co-morbidities.

The reasons for obesity are many and complex. It is not simply a result of overeating. Research has shown that in many cases a significant, underlying cause of morbid obesity is genetic. Studies have demonstrated that once the problem is established, efforts such as dieting and exercise programs have a limited ability to provide effective long-term relief. Environmental factors, such as fast food, long days sitting at a desk, and suburban neighborhoods that require cars all magnify hereditary factors such as metabolism and efficient fat storage. Science continues to search for answers. But until the disease is better understood, the control of excess weight is something patients must work at for their entire lives.

Morbid obesity increases the risk of developing heart disease, high blood pressure (also known as hypertension), high blood cholesterol, sleep apnea, respiratory insufficiency, obesity hypoventilation syndrome, asthma and bronchitis, degenerative disease of the Lumbo-Sacral spine, degenerative arthritis of weight-bearing joints, heartburn or reflux disease, diabetes mellitus, gallbladder disease, stress urinary incontinence, venous stasis disease, and emotional or psychological diseases, such as depression – to name a few.

Three criteria are used to determine whether a patient is morbidly obese.

These criteria are:

1. If you are more than 100 lbs. over your ideal body weight,

2. or you have a body mass index (BMI) of greater than 40,

3. or if your BMI is more than 35, and is accompanied by serious co-morbidity.

The primary goal in managing and treating obesity is to decrease a patient’s medical risk and improve quality of life. An appropriate weight management program combines physical activity, diet, behavioral modification, psychological counseling, and sometimes drug therapy to help patients achieve weight loss or prevent further weight gain. Surgery is reserved for patients who have repeatedly failed to lose weight by all other means (diet, exercise, behavioral and drug therapy) and this is the last resort. Surgical treatment is medically necessary because it is the only proven method of achieving long term weight control for the morbidly obese.

Weight loss surgery is major surgery. Although most patients enjoy an improvement in obesity-related health conditions (such as mobility, self-image and self-esteem) after the successful results of weight loss surgery, these results should not be the overriding motivation for having the procedure. The goal is to live better, healthier and longer. You should make the decision to have weight loss surgery only after careful consideration and consultation with an experienced bariatric surgeon or a knowledgeable family physician. A qualified surgeon should answer your questions clearly and explain the exact details of the procedure, the extent of the recovery period and the reality of the follow-up care that will be required. They may, as part of routine evaluation for weight loss surgery, require that you consult with a dietitian/nutritionist and a psychiatrist/therapist. This is to help establish a clear understanding of the post-operative changes in behavior that are essential for long-term success. It is important to remember that there are no ironclad guarantees in any kind of medicine or surgery. Weight loss surgery will only succeed when the patient makes a lifelong commitment. Surgery is only a tool. Your ultimate success depends on strict adherence to the recommended dietary, exercise and lifestyle changes.

Some of the specific risks related to weight loss surgery include:

• Anastomotic leak, which is leaking from the staple line around the newly formed pouch or at any new connections that have been made, including to the small intestine,
• Dehiscence, which occurs when there is an opening or splitting apart of the surgical suture line.
• Gastric Fistula, which may occur when there is abnormal connection with the stomach, usually to other organs in the body.
• Pulmonary Embolism, which is one of the most common risks or complications of any surgery. Usually a blood clot that is causing blockage of an artery in the lungs that has normally formed in the legs, and moved its way up. The result of this can be a heart attack, or even death. It is very important to get patients out of bed quickly after surgery and moving around. In addition, anti-clotting medications are given.
• Wound Infection – This is when there is a penetration of bacteria to the site of surgical incision, and/or…
•  Wound Seroma – This is when there is a mass at the site of surgical incision caused by fluid within the tissue.

To try to reduce some risk, you can do the following at least two months before surgery: increase physical activity, lose 10% of body weight, quit smoking, and quit drinking alcohol. Doing these things can not only help to reduce your risk but will also help to optimize your recovery.

Six weeks of no strenuous activities. Most office and routine work can be resumed in three (3) weeks. The lap-band recovery is typically a week. Most patients completely recover in six weeks to three months. How quickly you return to work will vary according to a) your physical condition, b) the nature of the work you do (i.e. desk job vs. construction work), and c) the type of weight loss surgery you had. Most patients are able to resume their jobs within six weeks of their procedure. Patients who have had a minimally invasive laparoscopic procedure (e.g. laparoscopic Roux-en-Y, Lap-Band surgery) may be able to return to work as soon as one to three weeks following surgery. Revision operations are due to outlet problems, fistulas, too much weight loss, and not enough weight loss. About 3% of patients a year will need revision operations. Some patients will need operations after surgery if they develop a leak.

No. Surgery is the beginning of a multidisciplinary process that includes exercise. There is a very special diet that MUST be followed after surgery, and you MUST commit to the program. Surgery provides a tool for weight loss with a lifetime commitment to change. Weight loss surgery is the beginning of a new life.

Weight loss will vary depending upon your weight prior to surgery. After your surgery, your choice of foods and level of activity will change. The majority of patients lose one-third of their original body weight within two years of surgery.

Yes. Any time you experience rapid weight loss, you can expect some hair loss. This is a temporary problem. It usually occurs during the third through the eleventh months after surgery, the period of rapid weight loss. Hair typically returns fuller and richer than before.

Yes, barring other outstanding fertility problems. It is recommended, however, that patients who undergo the gastric bypass procedure wait at least one to two years after weight loss surgery to get pregnant because of the element of malabsorption involved.

Exercise can help, but if you lose an excessive amount of weight, more than likely you will have hanging skin. Often the skin returns, much as after pregnancy. Exercise is recommended to help tone the muscles and the skin. Some patients will want plastic surgery to help the problem areas, although we suggest patients wait for two years after weight loss surgery because a) there will be less skin to remove, and b), you might not need the plastic surgery.

Weight loss surgery, as stated previously, is only a tool that must be used to help control your weight. If you do not use the tool properly, you will regain some of the weight you lose. Weight loss surgery provides you with an opportunity to change your lifestyle and eating habits, thus making weight control easier in the long run.

Joining a support group is not required. However, the widespread use of support groups has provided many weight loss surgery patients an excellent opportunity to discuss their various personal and professional issues. Most patients learn in support groups, for instance, that weight loss surgery will not immediately resolve existing emotional issues or heal the years of damage that morbid obesity might have inflicted on their emotional well-being. Most bariatric surgeons who frequently perform weight loss surgery will tell you that ongoing post-surgical support helps produce the greatest level of success for their patients.