People with type 2 and obesity who are considering gastric bypass surgery first need to learn what exactly is a gastric bypass operation.

The gastric bypass is a surgical method of drastically reducing the size of the stomach and rerouting food around the first part of the small intestine, where much of the carbohydrate, fat and protein are normally absorbed. These mechanical changes, together with changes in the hormones of the gut, can lead to a loss of 100 to 150 pounds within a year or two of a successful gastric bypass.

However, every prospective candidate must also understand what this procedure is not:

• It is not a quick fix for the majority of obese people.
• It is not cosmetic surgery.
• It is not a way to get a movie-star figure.
• It is not an option for most obese people.

Who Is a Candidate?

Candidates for the surgery are usually selected only after a documented long-standing history of failure with dietary and medical weight-loss therapies. The gastric bypass is the best option for those people who are morbidly obese with serious medical conditions arising from or greatly worsened by their obesity.

These conditions include:

• Type 2 diabetes, and its complications
• Hypertension
• Sleep apnea
• Elevated cholesterol
• Osteoarthritis, especially of the knees
• Fatty liver

Does Gastric Bypass Reverse Type 2 Diabetes?

In the overwhelming majority of cases, the answer is yes, as long as the weight loss is maintained.

A 20-year study of the so-called Greenville gastric bypass, which was pioneered by Walter Pories, MD, and colleagues at East Carolina University, found that about 80 percent of people with pre-existing type 2 (whether on insulin or oral agents) had normal blood glucose without any treatment after this surgery. Most of the patients were able to stop insulin within a week of the surgery, and their blood glucose and A1Cs normalized without any medication by three months after surgery and before most of the weight was lost, a finding that supports the benefit of improving the patient’s insulin resistance with this marked reduction in caloric intake.

The 20 percent of patients whose diabetes did not resolve were typically those who were older and who had the longest duration of type 2—usually over 20 years. This suggests that in these patients, their beta cells had been “exhausted” by the many years of insulin resistance, and even a loss of 150 or more pounds was not able to restore the beta cells to normal. Nonetheless, most of these patients had a much easier time managing their diabetes with insulin than prior to the surgery.

In addition, patients who underwent the traditional gastric bypass lost more weight and were more likely to have 100 percent normalization of their hyperglycemia and insulin resistance than those who underwent the lap-band procedure.

Most patients who undergo gastric bypass surgery no longer need to take medications for high cholesterol or triglycerides and can reduce most of their antihypertensive medications. Those with sleep apnea usually no longer need their C-pap machine once they have lost a significant amount of weight. Many patients with arthritis are able to resume walking and may be able to avoid surgical replacement of their knees if the procedure is done in time.

GREENVILLE BYPASS (also known as Roux-en-Y gastric bypass or RGB)

This operation is the most common and successful malabsorptive surgery. First, a small stomach pouch is created to restrict food intake. Next, 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). This bypass reduces the amount of calories and nutrients the body absorbs.

ADJUSTABLE GASTRIC or lap-banding procedure

In this procedure, a hollow band made of a special material is placed around the stomach near its upper end, creating a small pouch and a narrow passage into the larger remainder of the stomach. The band is then inflated with a salt solution. It can be tightened or loosened over time to change the size of the passage.

Typical Meal One Year After Bariatric Surgery

• One 2-ounce broiled hamburger or chicken breast
• ¼ cup boiled carrots
• ¼ cup pasta salad
• 1 teaspoon soft margarine
• ½ cup milk
• Multivitamins

Some of the Downsides of Gastric Bypass Surgery

First of all, you will no longer be able to eat as you did before having the operation (see above). You will have to get accustomed to eating much smaller portions and savoring each bite.

Then there is the cost of the surgery, and the preparation, and possible complications, which can include:

• Postoperative infections
• Anemia
• B12 and other vitamin deficiencies
• Inadequate weight loss
• Gallstones

The key to limiting complications and getting the best possible result is selecting an experienced surgeon and surgical team and a top-notch hospital for the procedure. Different surgeons have expertise in various surgical methods, including the use of the reversible lap-banding procedure. Most surgeons are able to reduce complications and length of stay by doing the procedure with a laparoscope instead of the more traditional and invasive “open” procedure that requires a much larger abdominal incision.

Resources for More Information

Weight-Control Information Network
1 Win Way
Bethesda, MD 20892-3665
Phone: (877) 946-4627
Web: WIN@info.niddk.nih.gov

American Society for Bariatric Surgery
140 NW 75th Drive, Suite C
Gainesville, FL 32607
Phone: (352) 331-4900
Fax: (352) 331-4975
Web: www.asbs.org

American College of Gastroenterology
Web: www.acg.gi.org/hdhome.html

North American Association for the Study of Obesity
Web: www.naaso.org

American Obesity Association
Web: www.obesity.org