How surgery works
The human body lays down fat stores if the calories in the food you
eat exceed the energy you burn up. There are a number of complex
processes which the medical profession are only just starting to
understand that seem to contribute to increasing obesity - the appetite
mechanisms go wrong and you continue to eat even though you do not need
the calories. And of course, once your body is carrying the extra
weight, it becomes harder to be physically active which would help to
regulate your weight.
Obesity surgery works by helping to reduce the number of calories
that are available in your body. There are two ways this can be
- Restriction - by reducing the size of the stomach, only small meals can be eaten and the appetite is satisfied
- Malabsorption - by bypassing part of the small intestine, less calories from food are absorbed by the body
The operations that work by restriction are:
The operations that work by a combination of restriction and malabsorption are:
There are different benefits and risks associated with each of these operations which are discussed more fully under each link.
In the UK, the National Institute for Clinical Excellence (NICE)
makes recommendations to the NHS about where and when surgical
procedures should be used. In 2002, they undertook a comprehensive
review of all the information available about obesity surgery,
including the results of all the studies conducted around the world.
NICE recommended that surgery should be an option for patients who have
a BMI over 40 kg/m2 (or 35 kg/m2 if they also
have an obesity–related disease). They did not distinguish between the
different surgical procedures available, recommending that choice be
made jointly by surgeon and patient. We entirely agree with this and
remind you that although the type of operation is an important factor
in how much weight you will lose, a big part of the treatment is your
willingness to change your eating and lifestyle habits to ensure you
have the most successful outcome.
Click here to read the full NICE guidance on surgery for morbid obesity.
Other specialist procedures
Although not strictly falling into the same class as the surgical
operations that have been discussed in this section, it is important to
mention intragastric balloons and intragastric stimulation, two new methods of weight loss that are becoming more widely available.
Neither of these is including in existing guidance published by
NICE, the UK government’s healthcare advisory body, so they are not
readily provided on the NHS. However a growing number of surgeons are
offering these procedures where they have been able to obtain special
funding, are undertaking research on them, or offer them to private