Introduction to Weight Loss Surgery

Patients often ask me: “Why will Weight Loss Surgery work, when I’ve already failed so
many diets”?

The key to weight loss surgery’s success is in providing relief from hunger. This relief
from hunger is called “satiety” and the ability to produce satiety is directly related to how much weight patients lose and how successful they are in the long run keeping it off.

Hunger, unfortunately, is not the result of any one single chemical or hormone in our
body (see Disease of Morbid Obesity Illustration). This is a prime reason that there will never be any single medication or “diet pill” that will work in everyone. In general when we eat it takes 30 minutes for the Fill Full signal or Satiety to reach our brains. We eat a meal, it enters our GI tract and begins to be absorbed and our fat cells produce a hormone called “Leptin” which goes to our brain via the blood stream to tell our hunger center we are full. It has been clearly demonstrated this “Leptin hunger switch” is broken in most morbidly obese patients, so we needs a substitute to trick the brain into feeling full.

Weight Loss Surgery can work several ways to provide satiety. The small gastric pouch
and small outlet let food empty slowly and reduce the volume of food which can be
eaten in 30 minutes. If you overeat you throw up. The small pouch has a nerve attached
(Vagus) which also goes to the hunger center, so when the small pouch is stretched
slightly for 30 minutes, it sends a nerve signal to the brain that we’re full. The basis for
all the modern weight loss operations (Gastric Bypass, Adjustable Bands, and Sleeve
Gastrectomy
) rely on this small pouch to contribute to hunger control. We substitute a
nerve signal for a blood hormone signal. This is where behavior modification comes in
and patients have a responsibility to change their eating habits to get the most benefit
from their surgery. We teach patients to eat slowly and focus on coarse fibrous foods
like meat veggies and fruit, limit simple carbohydrates and avoid high calorie liquids,
and to eat every 4 hours so their metabolism stays steady and they don’t over eat the
next meal. Skipping meals sends a signal to the body that you are starving and slows
your metabolism so it makes it harder to lose weight. This is the reason you regain more
weight than you lost on a diet when you resume eating the same amount of calories you
ate before the diet. This is called “Yo Yo dieting”. The addition of exercise increases the
calories you burn and improves weight loss while rebuilding muscle which burns calories
better and tightens loose saggy skin.

Another “Hunger Hormone” called “Ghrelin” is produced in the stomach along the large side of the stomach near the top. This hormone has been shown to be permanently reduced after Gastric Bypass and Gastric Sleeve. This improves satiety and weight loss compared to the Laparoscopic Adjustable Gastric Band procedures (Lap Band©, Realize Band©).

Disease of Morbid Obesity

Finally, procedures like the Gastric Bypass and Duodenal Switch bypass a portion of the small bowel where all absorption of calories and nutrients occur. (Nothing is absorbed in the stomach.) This reduces calories absorbed, but also produces additional hormones which interfere with appetite and also bypasses some GI tract hormones which increase appetite. The more small bowel which is bypassed the more weight loss observed, but also the risk of nutritional deficiencies goes up. The length of the small bowel varies
considerably from 400 cm to 900 cm (16- 36 feet) and there is no clear guideline on what is the most appropriate length of bowel to bypass for a particular individual. The Gastric Bypass is considered a “proximal bypass” since it rarely exceeds 150cm of bypassed bowel and the Duodenal Switch is a “distal bypass” since nearly all the small bowel is
bypassed.

Dr Champion and the Videoscopic Institute of Atlanta PC limits the procedures
performed to the Roux Gastric Bypass, Laparoscopic Adjustable Gastric Bands and the
Gastric Sleeve as these balance good weight loss with a minimum of nutritional issues
and complications. Patients who wish to consider the Duodenal Switch should contact
the American Society for Metabolic and Bariatric Surgery or the American College of
Surgeons for a referral to a surgeon in their area who performs these procedures.

The answer to the question?

Weight loss surgery works where diets have failed because they produce hunger
control or Satiety which allows you to have control over food. Diets fail because the
longest most patients can stay on them is 6 months and when they resume eating
a normal amount of food they regain all their weight and more. Morbidly obese
patients have a broken metabolism which only requires around 1200 calories of
food daily. If they eat 1600-2000 calories they will gain 6-10 pounds yearly. Morbid
Obesity is a metabolic disease which is best treated with bariatric surgery to allow
patients to match their food intake with their body’s metabolism.