- What is Weight Loss?
- How does surgery help with weight loss?
- What is short term versus long term weight loss?
- Conditions Improved with Weight Loss
- Understanding the Impact of Obesity.
Many medical conditions seem to improve with significant weight loss. However complete improvement or “cure” cannot be predicted, because many of the conditions are also related to genetics and aging. In other words, there are many people of normal weight and size who may still develop these conditions.
Diabetes (Adult onset)
Over 50% of patients are able to reduce their diabetic medications with substantial weight loss. Diabetesseems to improve most dramatically with the roux-en-y gastric bypass. Although much of theimprovement is related to the loss in weight, a significant portion of the improvement may be related to the operation itself and the way it reroutes the stomach and intestines. After a roux en y gastric bypass, 95% of younger patients (and 80% of all patients) are able to eliminate medications (oral and insulin) for diabetes. For the sleeve gastrectomy and the lap band, the improvement in diabetes is proportional to the amount of weight lost. Thus, for those patients who lose weight, there can be a 50 to 70% improvement in the need for diabetic medications.
Acid reflux and heartburn often improve with a change in diet and lower abdominal pressure with weight loss. It is important to realize that some operations such as the lap band and gastric sleeve may worsen heartburn, while others such as the roux en y gastric bypass reduce heartburn by bypassing the acid producing portion of the stomach.
About 70% of patients will have significant improvement in blood pressure. (Only about 30% can eliminate all medications for blood pressure)
About 70% to 80% of patients will have minimal symptoms of apnea after surgery. About 50% will eliminate the need for a CPAP machine.
Improvements in cardiac function and heart muscle function have been studied, and often seem to improve.
Lowering of previously high cholesterol and lipid levels are common, possibly resulting in a decreased risk of heart attack and cardiovascular disease.
Pseudo Tumor Cerebri
Headaches and visual changes seem to improve in many.
Infertility seems to improve in many women with polycystic ovary disease or irregular periods.
Young patients who do not require NSAIDs for pain control usually report significant improvement in joint stress and pain. However, patients who already have documented arthritis (inflammation and degeneration of the joints) may continue to progress with arthritis. In addition, patients who depend on NSAIDs for pain control may experience more pain after gastric bypass since NSAIDs are no longer allowed after the operation.
Most patients have mild to significant improvement, due to less restriction of the lungs (ability to take deeper breaths).
Restrictive lung disesase
Decreased lung function can result from a combination of several factors. Lung function can be impaired by obstructive disease (COPD, asthma), destruction of lung tissue (emphysema, pulmonary fibrosis), and restriction (lung scarring, obesity). Obesity may limit one’s ability to take a deep breath and expand thelungs. The extra weight also places more demand on the lungs and heart to supply oxygen. If this is a major reason for poor lung function, then weight loss can result in significant improvement. However, pulmonary function tests are required prior to the operation to help sort this out.
Incontinence is a complex problem that can be related to increased abdominal pressure and abnormal anatomy. Mild cases of incontinence or increased frequency related to increased abdominal pressure may improve with significant weight loss.
Hernias (holes or tears in the abdominal wall allowing the bowels to bulge through) always require surgical correction. Sometimes these can be corrected at the same time as weight loss surgery. Once the hernia is fixed, the repair is probably more durable due to the lower weight and lower abdominal pressure.
Psychological conditions can be very complex. Depression may seem to improve for a short time with rapid weight loss, but usually persists in the long term. Some patients may face increased stress as their self perception and relationships change. Others will no longer be able to use food as a source of comfort during times of depression.Medications for depression and other psychological conditions can still be taken immediately after the operation. Occasionally dosages may have to be adjusted as weight is lost.
Recent research has suggested that obesity may increase the risk of the conditions below. However, not enough research has been done to determine whether significant weight loss can reverse or reduce the risk of these conditions.
- Cancer risk (uterine and breast cancer)
- Deep venous thrombosis
- Pulmonary Emboli
- Heart Attack
- Immune Suppression