Multiple reports that more and more adults and even children have become morbidly obese in the United States have led to searches for effective interventions. One of the interventions beginning to receive widespread use is gastric bypass surgery, which limits the amount of food an individual can consume and thus helps prevent overeating that leads to or supports a state of obesity.
The articles selected for review in this paper related to gastric bypass surgery demonstrate both the growing population and success of this surgery and information regarding concerns about both safety and efficacy of the approach. The paper will provide an overview of discussion regarding gastric bypass surgery including benefits and risks.
Sugarman (2002) compared Roux-en-Y gastric bypass with other types of surgery and found it to be superior, resulting in loss of up to two-thirds of body weight within two years. He noted significant complications including a mortality rate of 1% of this type of surgery, with more deaths in extremely obese patients, and reported that the surgery often resulted in nutritional problems that had to be resolved with supplements. Nevertheless, he found that patients as a group greatly decreased their degree of obesity, often within months; that sleep apnea either resolved or improved significantly, to the point that many could stop using CPAP machinery during sleep. Urinary incontinence improved 95% of the time along with dramatic improvements in both blood pressure and diabetes. The problem of acid reflux was more complex, with improvements in some patients and deterioration in others.
Berke (2000) wrote about the medical management of patients receiving gastric bypass surgery. He pointed out the current need for such surgery in that obesity leaves patients at risk for other serious illness including osteoarthritis, diabetes, heart disease and high blood pressure. He pointed out that traditional, more conservative approaches including diet and exercise did not always help those who were extremely obese, and that some patients’ overall deteriorating health demanded a more time-efficient solution. He demonstrated that obesity can have multiple causes and that medical science does not have non-surgical solutions for all of them yet. Berke took a conservative approach, outlining when patients might be candidates for either lifestyle change or pharmaceuticals as a better approach. He listed the typical benefits and common side effects of the drugs currently available, noting that some of the side effects of these meds, including high blood pressure, could be problematical for patients whose obesity had already caused or contributed to hypertension. He warned that although the risks for specific individuals in gastric bypass surgery can be significant, for some patients, rapid reduction in weight is so desirable that the potential benefits outweigh the potential risks. He noted that gastric bypass is a significant intervention but that it can be an effective treatment for the morbidly obese.
Bock-Lopez (2001) notes that while gastric bypass surgery can be an effective treatment for morbid obesity, patients receiving this treatment need careful, long-term follow-up to maintain the weight loss and to manage any negative effects of the surgery. She notes that obesity is a growing problem in the United States and that it contributes to a wide variety of other medical problems including back pain, infertility and liver malfunction as well as the more commonly known ones such as cardio-vascular problems and diabetes. She notes that the traditional treatments for mild obesity, such as reduced-calorie diets, increased exercise, dietary and behavioral changes or medication, often to not result in enough weight loss to reduce health risks for those who are severely or morbidly obese. She notes that in one study, over two years, gastric bypass surgery resulted in 42% reduction in hypertension, 47% reduction in Type 2 diabetes, and 65% reduction in sleep apnea when compared to a dietary approach. She explained how the most common type of surgery changes food absorption: a section of small intestine is rerouted to a “created stomach pouch,” thus eliminating part of the digestive tract. This both restricts how much food the individual can consume and prevents absorption of some of the food consumed.
Bock-Lopez provided more details than the other two authors regarding possible complications or side effects. They included risks common to many surgeries, such as the possibility of deep-vein clot formation, infection, and pneumonia. Difficulties specific to this surgery included increased risk of pulmonary embolism, and later complications such as intestinal blockage, the need to eat markedly small meals at first (one ounce), the need to support surgery with lifestyle changes, and supplements to maintain adequate nutrient intake. She included specific guidelines for post-operative nursing procedures.
As shown in these three articles, gastric bypass surgery can be an effective tool to help patients fight obesity, but it can have significantly negative effects on nutrition and even cause death in relatively rare cases. It is a markedly invasive solution, and candidates for this surgery should be chosen with care. All three authors saw gastric bypass as an option when obesity was severe and when more conservative approaches had failed to be satisfactorily effective.
Berke, Ethan M. 2000. “Medical Management of Obesity.” American Family Physician, July 15.
Bock-Lopez, Michelle. 2001. “Hope for the morbidly obese.(bariatric surgery).” RN, Dec.
Sugerman, Harvey J. 2002.
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