A New Direction In Weight Control Gastric Bypass Surgery

For patients who suffer from severe obesity and its associated medical complications, weight loss surgery can be a viable option. There are two common surgical procedures to achieve this goal: gastric bypass and gastroplasty. Both procedures involve reducing the size of the stomach to a pouch that is smaller than an egg, which greatly restricts the amount of food that can be consumed in one sitting. These surgeries typically result in a 25 to 35 percent reduction in weight within the first year, with most of the weight loss being sustained for up to five years. Additionally, the serious medical conditions that accompany extreme obesity tend to significantly improve after surgery.

However, it's important to note that surgery is not without risks and should only be performed by experienced and skilled surgeons. Patients should also be provided with a comprehensive program for long-term weight control.

Following surgery, dietary modifications are necessary, as the limited gastric capacity and narrow anastomotic gastrointestinal stoma require a special approach to eating. There is no standard gastric bypass diet, but most patients typically start with a liquid diet due to the small and edematous gastric outlet. 

This phase can last anywhere from one day to six weeks, followed by the introduction of pureed textures and gradually advancing to soft-textured foods by 12 weeks. Small, frequent meals rich in protein are encouraged, and liquids should be consumed between meals to facilitate the intake of calories and protein from solid foods. It's recommended to avoid carbonated drinks, tough meats, breads, and milk products as they may cause discomfort. Until solid food intake is sufficient, high-protein liquid supplements like sugar-free Carnation Instant Breakfast (mixed with low lactose milk if necessary) may be recommended.

During the first six to 12 months after surgery, patients usually consume between 900 to 1000 calories, with calorie consumption gradually increasing as the pouch size, stoma size, gastric emptying rate, and solid food intake change. Sugary and highly concentrated sweets should be avoided to prevent dumping syndrome. The bypass of the pyloric sphincter causes simple sugars to be rapidly dumped into the small intestine, resulting in an increase in the osmotic load, fluid buildup, and symptoms such as diarrhea, nausea, sweating, and abdominal cramps. Many patients may experience a perceived decrease in blood volume 30 minutes to an hour after a meal, which may prompt them to lie down to improve cardiac output.

On average, gastric bypass patients typically lose 50 to 75 percent of their excess body weight and are successful in maintaining their weight loss.

The obesity epidemic, especially among the morbidly obese, is growing rapidly in the United States. Traditional weight loss programs have been found to be ineffective in this population, so gastric bypass surgery may be an option to improve quality of life and decrease the comorbidities associated with obesity.