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Home > Minimally Invasive Surgery > Gastric Bypass

Obesity - Gastric Bypass Surgery

Obesity is defined as having an excessive amount of body fat. Obesity is more than just a cosmetic concern, though. It increases your risk of diseases and health problems such as diabetes and high blood pressure.

Doctors often use a formula based on your height and weight - called the body mass index (BMI) - to determine if you are obese. Adults with a BMI of 30 or higher are considered obese. Extreme obesity, also called severe obesity or morbid obesity, occurs when you have a BMI of 40 or more. With morbid obesity, you are especially likely to have serious health problems.


Weight status

Below 18.5


18.5 — 24.9


25.0 — 29.9


30.0 and higher


Symptoms of Obesity

Symptoms associated with obesity can include : -

  • Difficulty sleeping
  • Snoring
  • Sleep apnea
  • Pain in your back or joints
  • Excessive sweating
  • Always feeling hot
  • Rashes or infection in folds of your skin
  • Feeling out of breath with minor exertion
  • Daytime sleepiness or fatigue
  • Depression

When to see a doctor

If you have symptoms associated with obesity such as the ones above, see your doctor or health care provider. You and your doctor can discuss your weight-loss options. Even modest weight loss can improve or prevent problems related to obesity. Weight loss is usually possible through dietary changes, increased physical activity and behavior changes. In some cases, prescription medications or weight-loss surgery may be options.

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Causes of Obesity

Although there are genetic and hormonal influences on body weight, the bottom line is that obesity occurs when you take in more calories than you burn through exercise and normal daily activities. Your body stores these excess calories as fat.

Obesity usually results from a combination of causes and contributing factors, including : -

  • Inactivity. If you're not very active, you don't burn as many calories. Unfortunately, today most adults spend most of their day sitting, whether at home, at work or during leisure activities. With a sedentary lifestyle, you can easily take in more calories every day than you burn off through exercise or normal daily activities. Watching too much television is one of the biggest contributors to a sedentary lifestyle and weight gain.

  • Unhealthy diet and eating habits. Having a diet that's high in calories, eating fast food, skipping breakfast, eating most of your calories at night, consuming high-calorie drinks and eating oversized portions all contribute to weight gain.

  • Pregnancy. During pregnancy a woman's weight necessarily increases. Some women find this weight difficult to lose after the baby is born. This weight gain may contribute to the development of obesity in women.

  • Lack of sleep. Getting less than seven hours of sleep a night can cause changes in hormones that increase your appetite. You may also crave foods high in calories and carbohydrates, which can contribute to weight gain.

  • Certain medications. Some medications can lead to weight gain if you don't compensate through diet or activity. These medications include some antidepressants, anti-seizure medications, diabetes medications, antipsychotic medications, steroids and beta blockers.

  • Medical problems. Obesity can sometimes be traced to a medical cause, such as Prader-Willi syndrome, Cushing's syndrome, polycystic ovary syndrome, and other diseases and conditions. Some medical problems, such as arthritis, can lead to decreased activity, which may result in weight gain. A low metabolism is unlikely to cause obesity, as is having low thyroid function.

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Risk factors of Obesity

Factors that may increase your risk of obesity include : -

  • Genetics. Your genes may affect the amount of body fat you store and where that fat is distributed. Genetics also may play a role in how efficiently your body converts food into energy and how your body burns calories during exercise.

  • Family history. Obesity tends to run in families. That's not just because of genetics. Family members tend to have similar eating, lifestyle and activity habits. If one or both of your parents are obese, your risk of being obese is increased.

  • Age. Obesity can occur at any age, even in young children. But as you age, hormonal changes and a less active lifestyle increase your risk of obesity. In addition, the amount of muscle in your body tends to decrease with age. This lower muscle mass leads to a decrease in metabolism. These changes also reduce calorie needs and can make it harder to keep off excess weight. If you don't decrease your caloric intake as you age, you'll likely gain weight.

  • Quitting smoking. Quitting smoking is often associated with weight gain. And for some, it can lead to a weight gain of as much as several pounds a week for several months, which can sometimes lead to obesity.

  • Social and economic issues. Certain social and economic issues may be linked to obesity. You may lack access to safe areas to exercise, you may not have been taught healthy ways of cooking, or you may not have the financial means to buy fresh fruits and vegetables or foods that aren't processed and packaged. In addition, some studies show that your social networks influence your weight - you're more likely to become obese if you have obese friends or relatives.

Even if you have one or more of these risk factors, it doesn't mean that you're destined to become obese. You can counteract most risk factors through diet, physical activity and exercise, and behavior changes.

Complications of Obesity

If you're obese, you're more likely to develop a number of potentially serious health problems, including : -

  • Blood (fat) lipid abnormalities
  • Cancer, including cancer of the uterus, cervix, ovaries, breast, colon, rectum and prostate
  • Depression
  • Gallbladder disease
  • Gynecological problems, such as infertility and irregular periods
  • Heart disease
  • High blood pressure
  • Metabolic syndrome
  • Nonalcoholic fatty liver disease
  • Osteoarthritis
  • Skin problems, such as intertrigo and impaired wound healing
  • Sleep apnea
  • Stroke
  • Type 2 diabetes

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Quality of life

When you're obese, your overall quality of life may be lower, too. You may not be able to get around or to perform normal daily activities as well as you'd like. You may have trouble participating in family activities. You may avoid public places. You may even encounter discrimination.

Other issues that may affect your quality of life include :-

  • Depression
  • Disability
  • Physical discomfort
  • Sexual problems
  • Shame
  • Social isolation

Tests and diagnosis of Obesity

If your doctor believes you are overweight or obese, he or she will typically review your health history in detail, perform a physical exam and recommend some tests. These can help confirm the diagnosis, check to see what may be contributing to your weight problem and also check for any related complications.

These exams and tests generally include :-

  • Taking your healthy history. Your doctor reviews your weight history, weight-loss efforts, exercise habits, eating patterns, what other conditions you've had, medications, stress levels and other issues about your health. Your doctor also may review your family's health history to see if you may be predisposed to certain conditions.

  • Assessing other health problems. If you have known health problems, your doctor will evaluate them. Your doctor will also check for other possible health problems, such as high blood pressure or binge eating disorder.

  • Calculating your BMI. Your doctor will check your body mass index (BMI) to determine your level of obesity. Your BMI also helps determine what other health problems you may face and what treatment may be appropriate.

  • Measuring your waist circumference. Fat stored around your waist, sometimes called visceral fat or abdominal fat, may further increase your risk of diseases such as diabetes and heart disease. Women with a waist measurement of more than 35 inches and men with a waist measurement of more than 40 inches may have more health risks than people with smaller waist measurements.

  • A general physical exam. This includes measuring your height, checking vital signs, such as heart rate, blood pressure and temperature, listening to your heart and lungs, and examining your abdomen.

  • Laboratory tests. What tests you have depend on your health and risk factors. They may include a complete blood count (CBC), a check of cholesterol and other blood fats, liver function tests, fasting glucose, a thyroid test, and others depending on your health situation. Your doctor also may recommend certain heart tests, such as an electrocardiogram.

Gathering all this information helps you and your doctor determine how much weight you need to lose and what health conditions or risks you have. And this will shape what treatment options are right for you.

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Treatments and drugs for Obesity

The goal of obesity treatment is to achieve and maintain a healthier weight to reduce your risk of serious health problems and enhance your quality of life. You may need to work with a team of health professionals, including a nutritionist, dietitian, therapist or an obesity specialist, to help you understand and make changes in your eating and activity habits.

Together, you can determine a healthy goal weight and how to achieve it. Your initial goal may be to lose 5 to 10 percent of your body weight within six months.

You can start feeling better and seeing improvements in your health with just minor weight loss, though - 5 to 15 percent of your total weight. That means that if you weigh 200 pounds (91 kilograms) and are obese by BMI standards, you would need to lose only about 10 to 30 pounds (4.5 to 13.6 kilograms) to start seeing benefits.

Specific treatment methods : -

There are many ways to treat obesity and reach a healthier weight. The treatment methods that are right for you depend on your level of obesity, your overall health, and your willingness to participate in your weight-loss plan. Think of your treatment plan as a way to make changes that you can stick with for a lifetime, so that you keep the weight off.

Treatment methods include : -

  • Dietary changes
  • Exercise and activity
  • Behavior change
  • Prescription weight-loss medications
  • Weight-loss surgery

Achieving a healthy weight is usually done by making changes in your lifestyle - dietary changes, increased activity and behavior change. Prescription medication or weight-loss surgery is typically used in addition to lifestyle changes in more serious cases.

Dietary changes : -

Reducing your daily calorie intake and eating healthier are vital to overcoming obesity. Slow and steady weight loss of 1 or 2 pounds (1/2 to 1 kilogram) a week is considered the safest way to lose weight and the best way to keep it off permanently. Avoid drastic and unrealistic diet changes, such as crash diets, because they're unlikely to help you keep excess weight off for the long term. There are a number of different dietary strategies to choose from, all of which can lower your calorie intake.

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Dietary ways to overcome obesity include : -

  • Reducing your calorie intake. The key to weight loss is reducing how many calories you consume. You and your health care providers can review your typical eating and drinking habits to see how many calories you normally consume and where you can cut back. You may be eating larger portions than you thought, or realize that your diet includes lots of fast food, sweets or sugary drinks.

    You and your doctor can decide how many calories you need to take in each day to achieve weight loss, but a typical amount is 1,000 to 1,600 calories.

  • Feeling full on less. The concept of energy density can help you satisfy your hunger with fewer calories. All foods have a certain number of calories within a given amount (volume). Some foods, such as desserts, candies and processed foods, are high in energy density. This means that a small volume of that food has a large number of calories. In contrast, other foods, such as fruits and vegetables, have low energy density.

    These foods provide a larger portion size with a fewer number of calories. By eating larger portions of foods less packed with calories, you squelch hunger pangs, take in fewer calories and feel better about your meal, which contributes to how satisfied you feel overall.

  • Adopting a healthy eating plan, such as the Mayo Clinic Healthy Weight Pyramid. To make your overall diet healthier, eat more plant-based foods, such as fruits, vegetables and whole grains. Also emphasize plant sources of protein, such as beans, lentils and soy, choose lean meats, and try to include seafood twice a week. Limit salt and added sugar. Stick with low-fat dairy products. And make sure fats come from healthier sources, such as nuts and olive, canola and nut oils.

    When you adopt an overall healthier diet, rather than trying a crash diet, you're more likely to follow it for the long term. The Mayo Clinic Healthy Weight Pyramid is one way to adopt a healthy, lifelong eating plan. This means no severe restrictions on the foods you eat and no extreme hunger. The base of the pyramid focuses on generous amounts of healthy foods that contain a small number of calories in a large volume of food, particularly fruits and vegetables.

    Healthy choices in moderate amounts make up the rest of the pyramid, which focuses on whole-grain carbohydrates, lean sources of protein such as legumes, fish and low-fat dairy, and heart-healthy unsaturated fats.

  • Following a very low calorie liquid diet if medically recommended. These mainly liquid diets are meant to provide rapid weight loss over the short term. They provide only about 600 to 800 calories a day. Your doctor may recommend a very low calorie diet if you need to lose weight quickly before a medical procedure or if you have serious health problems.

    Don't try it on your own. You need close monitoring by your health care providers to avoid complications. You also may need to take vitamin or nutritional supplements. While you may be able to lose weight quickly on a very low calorie diet, you're also likely to regain it quickly once you stop the diet. To prevent weight regain after a very low calorie diet, you must make changes in your overall diet, activity level and behavior.

  • Meal replacements. These plans suggest that you replace one or two meals with their products - such as low-calorie shakes or meal bars - and eat healthy snacks and a healthy, balanced third meal that's low in fat and calories.

    In the short term, this type of diet can help you lose weight, and they may be a good option if they help you control portion size, limit calories and encourage healthy eating. Keep in mind that these diets likely won't teach you how to change your overall lifestyle, though. So while they may work for some, you might find it hard to maintain your weight loss over the long term.

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Be wary of quick fixes : -

You may be tempted by fad diets that promise fast and easy weight loss. The reality, however, is that there are no magic foods or quick fixes. Special diets such as low-carbohydrate diets may produce weight loss in the short term, but the long-term results don't appear to be any better than other diets.

Similarly, you may lose weight on a crash diet, but you're likely to regain it when you stop the diet. To lose weight - and keep it off - you have to adopt healthy eating habits that you can maintain over time.

Increased activity

Increased physical activity or exercise is also an essential part of obesity treatment. Most people who are able to maintain their weight loss for more than a year get regular exercise, even simply walking. The goal of activity and exercise for weight loss is to burn more calories, although exercise offers many other health benefits as well. How many calories you burn depends on the frequency, duration and intensity of your activity.

To boost your activity level : -

  • Exercise. One of the best ways to lose body fat is through regular aerobic exercise, such as walking, cycling, stair climbing or swimming. The American College of Sports Medicine recommends that people who are overweight or obese get at least 150 minutes a week of moderate-intensity physical activity to prevent further weight gain or to lose a modest amount of weight.

    But to achieve significant weight loss, you may need to get as much as 250 to 300 minutes of exercise a week, it says. You probably will need to gradually increase the amount you exercise as your endurance and fitness improve. To make your own exercise goal more doable, break it up into several sessions throughout the day, doing just five or six minutes at a time.

    Don't set your goals unrealistically high, or you may give up. Your doctor can help you create an exercise plan that's appropriate for your specific situation and abilities.

  • Increase your daily activity. Even though regular aerobic exercise is the most efficient way to burn calories and shed excess weight, any extra movement helps burn calories. Making simple changes throughout your day can add up to big benefits. Park farther from store entrances, rev up your household chores, garden, get up and move around periodically, and wear a pedometer to track how many steps you actually take over the course of a day.

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Behavior changes : -

To lose weight and keep it off, you need to make changes in your behavior and attitudes toward food and exercise. A behavior modification program can help you make these lifestyle changes. Behavior modification programs may include examining your current habits to find out what factors or situations may have contributed to your obesity. Exploring your current eating and exercise habits gives you a place to start when changing your behaviors.

Once you understand which habits are undermining your weight-loss efforts, you can take steps to create a new, healthier lifestyle. There are a number of ways to help you change unhealthy behavior and thoughts.

Behavior modification, sometimes called behavior therapy, can include : -

  • Counseling. Therapy or interventions with trained mental health or other professionals can help you address emotional and behavioral issues related to eating. Therapy can help you understand why you overeat and learn healthy ways to cope with anxiety.

    You can also learn how to monitor your diet and activity, understand eating triggers and cope with food cravings. Counseling may be available by telephone, e-mail or Internet-based programs if travel is difficult. Cognitive behavioral therapy is a type of therapy frequently used for weight loss. Therapy can take place on both an individual and group basis.

  • Support groups. You can find camaraderie and understanding in support groups where others share similar challenges with obesity. Check with your doctor, local hospitals or commercial weight-loss programs for support groups in your area, such as Weight Watchers.

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Weight-loss surgery

In some cases, weight-loss surgery, also called bariatric surgery, is an option. Weight-loss surgery offers the best chance of losing the most weight, but it can pose serious risks. Weight-loss surgery limits the amount of food you're able to comfortably eat or inhibits the absorption of food and calories, or both.

Weight-loss surgery for obesity may be considered if : -

  • You have extreme obesity, with a body mass index (BMI) of 40 or higher
  • Your BMI is 35 to 39.9, and you also have a serious weight-related health problem, such as diabetes or high blood pressure
  • You're committed to making the lifestyle changes that are necessary for surgery to work

Weight-loss surgery can often help you lose as much as 50 percent of your excess body weight. Just over half of those who undergo weight-loss surgery keep the weight off at the 5-year mark. But weight-loss surgery isn't a miracle obesity cure. It doesn't guarantee that you'll lose all of your excess weight or that you'll keep it off long term. Weight-loss success after gastric bypass surgery depends on your commitment to making lifelong changes in your eating and exercise habits.

There are numerous types of weight-loss surgery. Some types are restrictive, causing weight loss by restricting how much your stomach can hold. Others are malabsorptive, because they prevent your body from absorbing calories and nutrients. Others are a combination of these two types.

More common weight-loss surgeries include : -

  • Gastric bypass surgery. This is the favored weight-loss surgery in the United States because it has shown relatively good long-term results. It combines both restriction and malabsorption to produce weight loss. In gastric bypass (Roux-en-Y gastric bypass), the surgeon creates a small pouch at the top of your stomach. The small intestine is then cut a short distance below the main stomach and connected to the new pouch.

    Food and liquid flow directly from the pouch into this part of the intestine, bypassing most of your stomach.

  • Laparoscopic adjustable gastric banding (LAGB). In this restrictive-type procedure, your stomach is separated into two pouches with an inflatable band. Pulling the band tight like a belt, the surgeon creates a tiny channel between the two pouches. The band keeps the opening from expanding and is generally designed to stay in place permanently.

    LAGB is gaining popularity because it generally causes slow, steady weight loss and the band can be adjusted if needed. However, as with other procedures, this won't work without changes in your behavior.

  • Biliopancreatic diversion with duodenal switch. In this malabsorption-type procedure, most of your stomach is surgically removed. This weight-loss surgery offers sustained weight loss, but it poses a greater risk of malnutrition and vitamin deficiencies, and you require close monitoring for health problems.

    It's generally used for people who have a body mass index of 50 or more.

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Complications of weight-loss surgery

Weight-loss surgery poses a threat of numerous serious health problems related to the surgery and your reduced food intake, including:

  • Pneumonia
  • Blood clots
  • Infection
  • Gallstones
  • Hernia
  • Nausea
  • Vomiting
  • Diarrhea
  • Nutritional deficiencies

Preventing weight regain after obesity treatment

Unfortunately, it's common to regain weight no matter what obesity treatment methods you try. But that doesn't mean your weight loss efforts are futile.

One of the best ways to prevent regaining the weight you've lost is getting regular physical activity. Keep track of your physical activity if it helps you stay motivated and on course. As you lose weight and gain better health, talk to your doctor about what additional activities you might be able to do and, if appropriate, how to give your activity and exercise a boost.

You may always have to remain vigilant about your weight. Combining a healthier diet and more activity is the best way to lose weight and keep it off for the long term. If you take weight-loss medications, you'll probably regain weight when you stop taking them. You might even regain weight after weight-loss surgery if you continue to overeat or eat foods laden with fat and calories. Take your weight loss and weight maintenance one day at a time and surround yourself with supportive resources to help ensure your success. Find a healthier way of living that you can stick with for the long term.

Lifestyle and home remedies

Your effort to overcome obesity is more likely to be successful it you follow strategies at home in addition to your formal treatment plan.

These can include : -

  • Stick to your treatment plan. Changing a lifestyle you may have lived with for many years can be difficult. Be honest with your doctor, therapist or other health providers if you find your activity or eating goals slipping. You can work together to come up with new ideas or new approaches.

  • Take your medications as directed. If you take weight-loss medications or medications to treat obesity-related conditions, such as high blood pressure or diabetes, take them exactly as prescribed. If you have a problem sticking with your medication regimen or have unpleasant side effects, talk to your doctor.

  • Learn about your condition. Education about obesity can help you learn more about why you became obese and what you can do about it. You may feel more empowered to take control and stick to your treatment plan. Read reputable self-help books and consider talking about them with your doctor or therapist.

  • Enlist support. Get your family and friends on board with your weight-loss goals. Surround yourself with people who will support you and help you, not sabotage your efforts. Make sure they understand how important weight loss is to your health. You might also want to join a weight-loss support group.

  • Set realistic goals. When you have to lose a significant amount of weight, you may set goals that are unrealistic, such as trying to lose too much too fast. Don't set yourself up for failure. Set daily or weekly goals for exercise and weight loss. Make small changes in your diet instead of attempting drastic changes that you're not likely to stick with for the long haul.

  • Identify and avoid food triggers. Distract yourself from your desire to eat with something positive, such as calling a friend. Practice saying no to unhealthy foods and big portions. Eat when you're actually hungry - not simply when the clock says it's time to eat.

  • Keep a record. Keep a food and activity journal. This journal can help you remain accountable for your eating and exercise habits. You can discover behavior that may be holding you back and, conversely, what works well for you. You also can use the journal to track other important health parameters such as blood pressure, cholesterol levels and overall fitness.

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Coping and support

Talk to your doctor or therapist about improving your coping skills, and consider these tips to cope with obesity and your weight-loss efforts:
  • Journal. Write in a journal to express pain, anger, fear or other emotions.
  • Connect. Don't become isolated. Try to participate in regular activities and get together with family or friends periodically.
  • Join. Join a support group so that you can connect to others facing similar challenges.
  • Focus. Stay focused on your goals. Overcoming obesity is an ongoing process. Stay motivated by keeping your goals in mind. Remind yourself that you're responsible for managing your condition and working toward your goals.
  • Relax. Learn relaxation and stress management. Learning to recognize stress and developing stress management and relaxation skills can help you gain control of unhealthy eating habits. Try such stress reduction techniques as meditation, yoga or tai chi, if your doctor says it's OK.

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