Obesity surgery is riskier after age 65 but still an option

Q. I'm 69 years old and I'm considering surgery for obesity. Am I too old for this?

There is no upper age limit for this type of surgery. However, the procedure is riskier for anyone older than 65.

Obesity surgery – also known as bariatric surgery – limits your food intake. Some operations also restrict the amount of food you can digest. It is designed for men who are at least 100 pounds overweight and women at least 80 pounds overweight.

Surgery is an extreme measure for people who can't lose weight through normal diet and exercise. Recent studies suggest that this kind of surgery may reduce death rates for the obese.

Now for some anatomy.

When we swallow, food moves down the esophagus to the stomach, where a strong acid continues the digestive process. The contents of the stomach move to the duodenum, the first segment of the small intestine. In the duodenum, bile and pancreatic juice speed digestion.

The jejunum and ileum, the remaining two segments of the nearly 20 feet of small intestine, complete the absorption of almost all calories and nutrients. The food particles that cannot be digested in the small intestine are stored in the large intestine until eliminated.

In the United States, surgeons use three types of operations most often: adjustable gastric band, gastric sleeve and gastric bypass. Surgeons use a fourth operation – biliopancreatic diversion with duodenal switch – less often.

In adjustable gastric band surgery, the surgeon places a ring with an inner inflatable band around the top of your stomach to create a small pouch. This makes you feel full after eating a small amount of food. The band has a circular balloon inside that is filled with salt solution. The surgeon can adjust the size of the opening from the pouch to the rest of your stomach by injecting or removing solution through a small device called a "port" placed under your skin.

In gastric sleeve surgery, a surgeon removes most of your stomach, leaving only a banana-shaped section that is closed with staples. This surgery reduces the amount of food that can fit in your stomach, making you feel full sooner. Taking out part of your stomach may also affect gut hormones or other factors such as gut bacteria that may affect appetite and metabolism.

Gastric bypass surgery has two parts. First, the surgeon staples your stomach, creating a small pouch in the upper section. The staples make your stomach much smaller, so you eat less and feel full sooner.

Next, the surgeon cuts your small intestine and attaches the lower part of it directly to the small stomach pouch. Food then bypasses most of the stomach and the upper part of your small intestine, so your body absorbs fewer calories.

The surgeon connects the bypassed section farther down to the lower part of the small intestine. This bypassed section is still attached to the main part of your stomach, so digestive juices can move from your stomach and the first part of your small intestine into the lower part of your small intestine.

The bypass also changes gut hormones, gut bacteria, and other factors that may affect appetite and metabolism.

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.

One study of bariatric surgery showed that patients lost an average of 61 percent of their excess weight. In addition to weight loss, these patients earned the health benefits that go with it. More than 7 out of 10 patients with diabetes, elevated cholesterol and high blood pressure improved so much that they needed less or no treatment for their conditions.