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No Easy

Fix

A 40-year-old woman

transforms her life after

weight-loss surgery, only to

see the pounds return and

her life spiral downward.

BY DOUGLAS G. ADLER

→

Rebecca came to my clinic

complaining of weight gain.

This wasn’t my usual case. As a

gastroenterologist, I typically hear

concerns over weight loss, which

suggests a serious medical condition.

Since adolescence, the 40-year-

old had struggled physically and

emotionally with obesity and eating

issues. About three years before

she landed in my office, she had a

gastric bypass procedure to help

her lose weight. The surgery was an

unqualified success, and Rebecca,

who had weighed 280 pounds, lost

120 pounds in one year and was

maintaining her new weight. She had

a slimmer appearance and a positive

outlook on life.

When I saw her at my clinic,

however, she was depressed and near

panic. She had gained 3 to 5 pounds

each month over the past six months.

The physical transformation she had

made was literally vanishing before her

eyes. She was struggling emotionally

because of it.

SURGERY COMPLICATIONS

Bariatric surgeries, which reduce

how much food someone can eat,

have become more common in recent

years. Three of the procedures are an

adjustable banded gastroplasty, which

constricts the stomach with a flexible

“belt”; sleeve gastrectomy, which cuts

away part of the stomach; and the

popular Roux-en-Y gastric bypass,

which involves tying off of the stomach

to make it smaller.

The surgeries can be quite successful.

Still, the complex procedures typically

involve reconstruction and rerouting of

the stomach and intestines. As a result,

the new connections can leak food or

be too tight and block food passage.

Both can lead to complications,

including life-threatening infections.

Moreover, patients must adopt a

major lifestyle change, committing

to regular exercise and a healthful

diet to maintain a reduced weight.

And the physical changes can set

off complicated emotions, which

is in part why patients undergo

psychological screening.

Rebecca had a Roux-en-Y gastric

bypass; her stomach was tied off to

create a pouch. Now the de facto

stomach, the pouch was surgically

connected to the middle of her small

intestine. People who have had this

surgery can eat only small meals and

don’t feel as hungry. And since the

food bypasses part of the intestines,

fewer nutrients are absorbed. The result

is dramatic weight loss.

Three common forms of bariatric surgery help obese people lose weight,

though the procedures are not without complications.

Sleeve gastrectomy Roux-en-Y gastric bypass

Stomach

pouch Adjustable band

Port placed

under skin

Gastric sleeve

(new stomach)

Removed portion

of stomach

Stomach

pouch

Bypassed portion

of stomach

Food

Digestive

juice

Adjustable banded gastroplasty

Vital

Signs