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Americans by the millions are going on diets, running, stepping and crunching to work off those excess pounds. Unfortunately, there are many young to middle-aged adults whose health is being jeopardized by morbid obesity'people who are at least 100 pounds overweight or twice their ideal weight. This excess weight often limits their ability to succeed and move ahead in both business and social situations. They also risk such life-threatening conditions as diabetes, cardiovascular disease, hypertension, orthopedic problems, gall bladder disease and sleep apnea.

Bariatric Surgery offers new hope

While numerous medical therapeutic approaches to morbid obesity have been advocated, including low-calorie diets, drugs, behavioral modification and exercise therapy, the majority of patients fail to maintain the reduced body weight. The only treatment proven effective in the long-term management of morbid obesity is bariatric surgery'such as a gastric bypass or the new gastric banding procedure.

New non-invasive techniques allow for faster, better recovery

Many morbidly obese patients are reluctant to undergo gastric bypass surgery'traditionally an open, invasive procedure. But thanks to new, minimally invasive surgical techniques, this 'last-resort' procedure has become more appealing. The non-invasive techniques use tiny slits in the abdomen that allow a surgeon to insert a camera-equipped scope and surgical instruments to perform surgical procedures. These techniques are equally successful and offer many added patient benefits. These benefits include less post-operative pain, reduced risk of wound infection, a shorter hospital stay, faster recovery and a more rapid improvement in quality of life. There are basically two types of laparoscopic surgeries to treat extreme weight loss.

Gastric Bypass'proven, effective, but irreversible

The most commonly known, Roux-en-Y gastric bypass, involves refashioning the stomach into a small pouch and bypassing part of the small intestine. This not only limits the absorption of food but also produces a feeling of fullness in less time. Although Roux-en-Y has been used for years with clinical results attesting to its effectiveness, the procedure is irreversible and patients are advised to thoroughly discuss its risk factors with their physicians.

Lap-Band Surgery'simpler, reversible with less risk

A newer, less extreme alternative is Lap-Band surgery, or adjustable gastric banding. Approved by the FDA just last year, the procedure involves less risk than the Roux-en-Y. Instead of bypassing the stomach, a 'balloon' is banded around the stomach to produce an early feeling of fullness. The balloon-like device is inserted through a small incision and inflate it with saline solution to cinch the stomach and limit its capacity. The operation takes about 60 minutes and usually requires a one-day hospital stay. The band can later be tightened or loosened as needed'without further surgery'by adjusting the amount of saline solution through a portal under the patient's skin. The device can even be removed entirely if necessary. Reduced risk, simplicity and reversibility make the Lap-Band more attractive to today's patients.

How much weight will I lose? How soon?

Results depend on a variety of factors and vary with each patient.

Most gastric bypass patients experience fairly rapid weight loss in the first three to six months after surgery. Weight loss slows, but generally continues up to 12 to 18 months after surgery, averaging 65 to 75 percent of excess body weight. With the Lap-Band, weight loss is generally slower and more gradual compared to the gastric bypass. Typically, patients lose up to 55 percent of their excess body weight within 18 months following laparoscopic adjustable gastric banding surgery. The normal hospital stay for Lap-Band patients is one day with a return to most activities in seven days.

Surgery is only the first step

Regardless of procedure, a team approach is recommended for solving a patient's weight problem. This includes a comprehensive evaluation and support before and after surgery for the greatest chance of weight loss success. The operation itself is not the whole answer. A multidisciplinary approach'surgeon, internist, dietician and psychiatrist'is needed to help the patient lose and keep weight off. The goal is not only weight loss, but the reversal of serious medical conditions.

Is it covered by my insurance?

Most insurance carriers will cover a laparoscopic gastric bypass if you are eligible for the procedure. Insurance coverage for laparoscopic adjustable gastric banding is variable and will depend on your insurance.