Know the pros and cons of obesity surgery

Q. New Jersey Gov. Chris Christie is in the news for getting obesity surgery. What exactly did he have done and does it work?

Gov. Christie had Adjustable Gastric Band (AGB) surgery which limits food intake with a band around the top of the stomach. The size of the restriction can be adjusted with a circular balloon inside the band. AGB works mainly by decreasing food intake. The snugger the band, the less hungry people feel.

AGB is one form of obesity - or bariatric - surgery. One study of this type of surgery showed that patients lost an average of 61 percent of their excess weight.

In addition to AGB, there are three other types of obesity surgery used in the USA:

Roux-en-Y Gastric Bypass reduces food intake and absorption. This is the most common obesity surgery. In gastric bypass surgery, the stomach is divided into two parts. Food is rerouted from the smaller upper part of the stomach, called the pouch, to the small intestine. Food no longer travels through the remaining part of the stomach    .

Duodenal Switch removes a large portion of the stomach, reroutes food away from much of the small intestine and also reroutes digestive juices.

Vertical Sleeve Gastrectomy involves removing a large portion of the stomach and creating a tubular gastric sleeve. The smaller stomach sleeve remains connected to a very short segment of the duodenum, which is then directly connected to a lower part of the small intestine. This operation leaves a small portion of the duodenum available for food and the absorption of some vitamins and minerals.

Obesity surgery is an extreme measure designed for men who are at least 100 pounds overweight and women at least 80 pounds overweight. There is no upper age limit for this type of surgery.

However, the procedure is riskier for anyone older than 65.

Obesity surgery may be done through a traditional abdominal opening or by laparoscopy, which requires only a half-inch incision.

The surgeon uses the small incision to insert instruments and a camera that transmits images to a television. Most bariatric surgery today is done laparoscopically.

Many people who have bariatric surgery lose weight quickly. If you follow diet and exercise recommendations, you can keep most of the weight off. The surgery has risks and complications including infections, hernias and blood clots.

Answers to the following questions from the National Institutes of Health may help people decide whether weight-loss surgery is right for them.

Is the overweight person:

• Unlikely to lose weight or keep it off over the long term using other methods?

• Well informed about the surgery and treatment effects?

• Aware of the risks and benefits of surgery?

• Ready to lose weight and improve his or her health?

• Aware of how life may change after the surgery? There are adjustments such as the need to chew food well and the loss of ability to eat large meals.

• Aware of the limits on food choices, and occasional failures?

• Committed to lifelong healthy eating and physical activity, medical follow-up, and the need to take extra vitamins and minerals?

Bariatric procedures, on average, cost from $20,000 to $25,000. Medical insurance coverage varies by state and insurance provider. In 2004, the U.S. Department of Health and Human Services reduced barriers to obtaining Medicare coverage for obesity treatments. Bariatric surgery may be covered under these conditions:

• If the patient has at least one health problem linked to obesity

• If the procedure is suitable for the patient’s medical condition

• If approved surgeons and facilities are involved