Frequently Asked Questions (FAQs)

What is Obesity?

How are Overweight and Obesity Defined?

What is a Bariatrician (aka, Obesity Medicine Physician)?

How Prevalent is Obesity?

What is Sleeve Gastrectomy?

How the sleeve gastrectomy procedure is done?

What is the main benefit of the sleeve gastrectomy over gastric bypass?

How large will my stomach be after surgery?

Is removing the stomach safe?

What is the difference between overweight and obese?

Is it possible to regain my weight?

Q.What is Obesity?

Ans:Obesity results from a complex interaction of genetic, behavioral and environmental factors causing an imbalance between energy intake and energy expenditure. According to the National Institutes of Health (NIH), an increase in body weight of 20 percent or more above desirable weight is the point at which excess weight becomes an established health hazard. Lower levels of excess weight can also constitute a health risk, particularly in the presence of other disorders like diabetes, hypertension and heart disease. Obesity has been recognized since 1985 as a chronic disease and is the second leading cause of preventable death, exceeded only by cigarette smoking. The United States currently is suffering an obesity epidemic contributing to the premature death, sickness and suffering of millions of Americans.

Q.How are Overweight and Obesity Defined?

Ans:There are several methods to measure obesity levels including Bio-electrical Impedance Analysis, Hydrostatic (underwater) Weighing and Dual Energy X-ray Absorptiometry. Bio-electrical Impedance Analysis is typically the most practical and convenient method used by bariatricians. The Body Mass Index (BMI) is a screening tool to identify people who may be at increased health risk due to being overweight or obese. The BMI formula = weight in pounds / (height in inches x height in inches) x 703. The following classifications for BMI were recommended by the National Heart Lung and Blood Institute:

  • Underweight: lower than 18.5
  • Normal weight: 18.5 to 24.9
  • Overweight: 25 to 29.9
  • Obesity: 30 to 34.9 (Class 1)
  • Obesity: 35 to 39.9 (Class 2)
  • Extreme Obesity: greater than 40 (Class 3)

Waist-to-hip measurements are also critical. These are obtained by dividing the circumference of an individual's waist by their hips. A healthy waist-to-hip ratio for women is no more than 0.8 and a healthy ratio for men is no more than 0.95.

Q.What is a Bariatrician (aka, Obesity Medicine Physician)?

Ans: A bariatrician is a licensed physician (M.D. or D.O.) who has received special training in obesity medicine--the medical treatment of obesity and its associated conditions. Bariatricians address the obese patient with a comprehensive program of proper diet and nutrition, appropriate exercise, lifestyle changes and, when indicated, the use of prescription anti-obesity medications and other appropriate medications. The word "bariatric" stems from the Greek word baros, which translates to "weight." While any licensed physician may offer a medical obesity treatment program to patients, members of the Society have been exposed, through an extensive continuing medical education (CME) program, to specialized knowledge, tools and techniques to enable them to design specialized medical obesity treatment programs tailored to the needs of individual patients and to modify the programs, if needed, as the treatment progresses. Physician-supervised medical obesity treatment programs support overweight and obese patient's overall health, since these frequently are accompanied by other medical conditions (e.g., type 2 diabetes, hypertension, cancer). An obesity medicine physician is trained to detect and treat these conditions, which might otherwise go undetected and untreated by a non-medical weight-loss program.

Q.How Prevalent is Obesity?

Ans: More than one-third of U.S. adults were obese in 2007-08. A 2007-08 data analysis indicated that the prevalence of obesity was 33.8 to 32.2 percent among men, and 35.5 percent among women. The estimates for overweight and obesity combined (BMI greater than or equal to 25) were 68.0 percent overall: 72.3 percent among men and 64.1 percent among women. Obesity prevalence varied by sex, age, race and ethnicity. These height and weight measurements were obtained from 5,555 adult men and women aged 20 years or older as part of the National Health and Nutrition Examination Survey (NHANES).

Q.What is Sleeve Gastrectomy?

Ans:Sleeve gastrectomy is a surgical weight-loss procedure generally done by laparoscopy where the stomach is reduced to about 25% of their original size. By laparoscopic surgery removal of a large area of the stomach is done , following a major curve. Outer edges stomach are then attached together often with surgical staples to create a sleeve or tube having a banana shape. The process permanently reduces the size the stomach. The procedure is performed laparoscopically and isn't reversible.

Sleeve gastrectomy is also called gastric sleeve is usually performed on extremely obese patients with BMI more than 35 - 40. This procedure is more popular nowadays because the chance of performing a gastric bypass or duodenal switch procedure might be too large. Patients usually lose a large volume of their excess fat after the sleeve gastrectomy procedure alone, but if weight loss ceases the second step of bypass is conducted in some patients.

For patients which are obese but not extremely obese, sleeve gastrectomy alone is a suitable operation with minimum risks. The sleeve gastrectomy currently is acceptable weight loss surgery option for obese patients as a single procedure. Most surgeons prefer to make use of a bougie between 32 - 60 Fr using the procedure and also the ideal approximate remaining size of the stomach after the procedure is about 15 mL.

Q.How the sleeve gastrectomy procedure is done?

Ans:The majority of weight loss sleeve gastrectomies performed today use a laparoscopic technique, which is considered minimally invasive. Laparoscopic surgery usually produces a shorter stay in hospital, faster recovery, smaller scars, and fewer pain than open surgical treatments.

The amount of time from the surgery varies. One study found that the average operative time was 1.5 to three hours and also the average hospital stay was 2 to 5 days. Patients usually go back to normal activities in 2 weeks and are fully recovered in 30 days.

Laparoscopic sleeve gastrectomy could possibly be the initial step before gastric bypass or it's really a single process of weight loss. If a sleeve gastrectomy can be used included in a two-step procedure, the initial step is for the surgeon to produce the small stomach "sleeve." Over time of time based on choices, another procedure would be completed in which the surgeon attaches a piece of the small intestine directly to the stomach pouch. This enables food to bypass some of the small intestine. Doing so enables your body to soak up fewer calories, in addition to consuming less food. This two-step procedure may be done because patients may not be able to tolerate both procedures throughout a single operation. Studies show that the two-step procedure has been utilized successfully in patients having a bmi greater than 50 or perhaps in high-risk patients.

Q.What is the main benefit of the sleeve gastrectomy over gastric bypass?

Ans: There is two benefits of the sleeve over a gastric bypass:

  • There is no malabsorption of nutrients or vitamins, unlike with gastric bypass. The risk of developing malnutrition or a vitamin deficiency thus remains really low.
  • The chance of a sleeve gastrectomy is slightly lower than a gastric bypass in most studies, the rate of weight reduction is about the same

Q.How large will my stomach be after surgery?

Ans:How big your stomach will be different with respect to the surgeon. All surgeons make use of a tube to guide them when stapling the stomach. This tube size can differ from as small as 32 French Bougie to as large as 64 French Bougie. This is a very important question to inquire about when it comes to this surgery, since those patients with larger pouches might have less weight loss.

Q.Is removing the stomach safe?

Ans:This kind of stomach removal has been performed with the Duodenal Switch procedure since the mid 1980's. It does involve stapling, just like within the gastric bypass and it has similar risks. Interestingly, patients do not ever return requesting their stomach back however, many do wonder if it is easy to reduce the size it again.

Q.What is the difference between overweight and obese?

Ans:An adult is considered "overweight" when he/she is above a healthy weight, which varies according to a person's height. An individual is overweight when their BMI is between 25-29.9. The standard used by researchers to define a person's weight according to their height is "body mass index" (BMI).

An adult with a BMI of 30 or more is considered obese. For example, for a 5'4" woman, this means that she is 30 or more pounds over her healthy weight. If your BMI = 35.0 - 40 you are severely obese (with risk factors morbidly). If your BMI = 40.0 and up you are morbidly obese.

Q.Is it possible to regain my weight?

Ans: Remember, your gastric bypass is only a tool. It is not a cure for obesity. Snacking, drinking with meals, drinking caffeinated and carbonated beverages, not drinking enough water in between meals and not exercising are common behaviors that will cause you to regain your weight.