| IntroductionAgainst a background of
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| | support, the weight loss is usually
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| widespread obesity among all US
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| | permanent. By comparison, according to
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| age-groups, and the relative failure of
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| | one 4-year study of non-surgical weight
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| conventional weight loss methods, doctors
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| | loss programs involving obesity
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| are increasingly resorting to
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| | medication, behavior modification, diet
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| gastrointestinal surgery in order to curb
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| | and exercise, average weight reduction
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| the rise of weight-related disease, and
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| | was 3 pounds in those subjects who were
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| associated costs. An estimated 170,000
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| | followed for the four years of the
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| weight loss surgeries will be performed
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| | study.What Are The Health Benefits of
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| in 2005, and although the average
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| | Surgery?According to the International
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| bariatric surgery patient is a woman in
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| | Federation for the Surgery of Obesity
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| her late 30s who weighs approximately 300
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| | (IFSO), weight reduction caused by
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| pounds, operations such as vertical
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| | gastric reduction surgery improves
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| banded gastroplasty and roux-en-Y bypass
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| | longevity and reduces rates of premature
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| are now being successfully conducted on
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| | death. In addition, hypertension is cured
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| patients as young as 13 years.But Does
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| | in about 50 percent of patients, while
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| Bariatric Surgery Work?While the
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| | measurements of cholesterol and other
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| increasing popularity of obesity surgery
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| | blood fats show visible improvements, all
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| is a clear reflection of the inability of
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| | leading to a reduction in the risk of
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| most obese patients to comply with
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| | heart disease. Type 2 diabetes is cured
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| conventional dietary treatments, the
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| | in 80 percent of diabetic patients while
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| question remains: does this type of
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| | hyperglycemia and associated conditions
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| surgical treatment offer an effective
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| | such as hyperinsulimia and insulin
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| solution for severe clinical obesity? To
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| | resistance are even more likely to
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| understand the issues raised by this
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| | benefit from gastric bypass. Obstructive
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| question, let us examine the problem of
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| | sleep apnea is cured in about 75 percent
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| obesity and how surgery attempts to
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| | of patients, shortness of breath is
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| reduce it.How Widespread is
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| | relieved in 75-80 percent of cases, while
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| Obesity?According to current statistics,
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| | asthma attacks are significantly reduced,
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| 61.3 million American adults (30.5
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| | particularly when associated with
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| percent) are obese. In addition, an
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| | gastroesophageal reflux disease. Obesity
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| estimated 10-15 percent of children (ages
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| | surgery also relieves low back pain and
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| 6?11) and 15 percent of teenagers are
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| | arthritis, heartburn, urinary
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| overweight and at risk of developing
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| | incontinence, and lower limb venous
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| weight-related disorders. Severe obesity
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| | disorders.What Are The Health
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| is also on the rise. Six million American
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| | Risks?Generally speaking, the health
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| adults are morbidly obese (BMI 40+),
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| | complications of bariatric surgery divide
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| while another 9.6 million have a BMI of
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| | into three classes. First, during the
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| 35-40. (Source: US Census 2000; NHANES
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| | operation itself, patients are subject to
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| III data estimates)How Does Obesity
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| | the normal health dangers of any serious
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| Affect Health?Excess body fat associated
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| | surgical procedure. Risk factors include:
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| with high body mass index (BMI) carries
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| | patient condition, the expertise of the
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| an increased risk of premature death.
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| | bariatric surgeon and anesthesiologist
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| Obese patients (BMI 30+) have a 50-100
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| | and the quality of operating room
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| percent increased risk of death from all
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| | services. Premature death occurs in about
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| causes, compared with individuals of
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| | 1-2.5 percent of bariatric cases. Second,
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| normal weight (BMI 20?25). Morbid obesity
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| | there are well-documented post-operative
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| (BMI 40+) and super-obesity (BMI 50+)
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| | health risks, which largely depend on the
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| carries a still higher risk of dying
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| | type of procedure
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| younger. Most of the increased risk is
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| | performed.Post-Operative Health Problems
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| due to co-morbid conditions like
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| | of Gastric BandingRestrictive procedures
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| cardiovascular disease (atherosclerosis,
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| | like gastric-banding and stomach stapling
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| heart attack or stroke). The effects of
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| | carry a number of short-term
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| severe obesity on longevity are dramatic.
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| | post-operative health risks, including:
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| Obese white males between 20 and 30 years
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| | (1) Risk of hernia. About 10-20 percent
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| old (BMI > 45) can shorten their life
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| | of patients require additional surgery to
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| expectancy by 13 years. African-American
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| | fix problems like abdominal hernias
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| men of similar age and BMI can lose up to
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| | caused by excessive straining after
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| 20 years of life. Obese white females
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| | surgery before the incision heals.
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| between 20 and 30 years old (BMI > 45)
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| | Laparoscopic surgery reduces this risk.
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| can shorten their life expectancy by 8
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| | (2) Risk of blood clots. About 1 percent
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| years. African-American women of similar
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| | of patients contract blood clots in the
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| age and BMI can lose up to 5 years of
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| | legs. (3) Risk of infection. On average,
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| life.Research Into Obesity and Premature
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| | there is a 5 percent risk of infection in
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| DeathA 12-year study of 330,000 obese men
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| | the incision area. (4) Risk of gastric
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| and 420,000 obese women, revealed that
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| | staple breakage. This occurs in bariatric
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| premature mortality rates for morbidly
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| | operations like vertical banded
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| obese men were twice the normal: 500
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| | gastroplasty, that use staples to reduce
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| percent higher for diabetics and 400
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| | stomach size. (5) Risk of band slippage
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| percent higher for those with digestive
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| | and saline leakage. A routine
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| tract disease. In severely obese women,
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| | complication, this occurs after lap band
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| the mortality was also increased two
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| | or other forms of adjustable gastric
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| fold, while in female diabetics the
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| | banding. (6) Risk of bowel obstruction.
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| mortality risk increased eight fold and
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| | This rare complication may occur due to
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| three fold in those with digestive tract
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| | adhesions caused by scar tissue. (7) Risk
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| disease. Another study of 200 men aged
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| | of stomal stenosis and marginal
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| 23-70 years with severe clinical obesity,
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| | ulcers.Post-Operative Health Problems of
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| showed a 1200 percent increase in
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| | Gastric BypassPost-operative health
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| mortality in the 25-34 year age group and
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| | dangers of bypass procedures like
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| a 600 percent increase in the 35-44 year
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| | roux-en-y or biliopancreatic diversion
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| age group. Average cancer mortality rates
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| | include: (1) Corrective operations. About
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| are 150-500 percent higher in obese
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| | 15-20 percent of bypass patients require
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| patients.Other Obesity-Related
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| | follow-up gastrointestinal operations to
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| DiseasesAside from premature death,
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| | correct complications (eg. hernias).
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| obesity is strongly associated with a
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| | These follow-up operations tend to carry
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| wide range of health disorders. 80
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| | higher risk of complication and death.
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| percent of patients with type 2 diabetes
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| | (2) Dumping Syndrome. Caused by
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| are obese, while almost 70 percent of
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| | overeating or over-rapid eating, dumping,
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| diagnosed heart disease is
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| | is not a real health danger, but symptoms
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| obesity-related. Other obesity-related
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| | (nausea, faintness, sweating and
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| disorders include: high blood pressure,
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| | diarrhea) can be distressing. (3) Risk of
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| cancer, carpal tunnel syndrome,
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| | nutritional deficiency. Since stomach
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| depression, gallstones, gastroesophageal
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| | bypass surgery involves bypassing the
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| reflux (GERD), insulin resistance, low
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| | duodenum and part/all of the jejunum,
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| back pain, obstructive sleep apnea,
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| | causing insufficient absorption of
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| musculoskeletal complaints and
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| | vitamins and minerals, patients can
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| osteoarthritis, respiratory problems,
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| | develop deficiencies in nutrients like:
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| stroke, and vein disorders.Why is
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| | iron, calcium, vitamin D and B12
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| Surgical Treatment is Needed?As the facts
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| | deficiency. This can be easily corrected
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| demonstrate, obesity is an independent
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| | by a program of nutritional
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| risk factor for a number of serious
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| | supplementation. (4) Risk of gallstones.
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| diseases. Severe obesity, if left
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| | About one-third of bypass patients
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| untreated, leads to life-threatening
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| | develop gallstones. (5) Bowel Disorders.
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| disorders and possible premature death.
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| | After all bypass operations, there is a
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| It is against this background that the
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| | period of intestinal adaptation during
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| viability of bariatric surgery should be
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| | which bowel movements can be liquid and
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| assessed. Three key questions are: (1)
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| | frequent. Typically accompanied by
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| Does bariatric surgery lead to a
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| | bloating, gas and foul smelling stools,
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| significant loss of weight? (2) What are
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| | this complaint may reduce with time, but
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| the health benefits of surgery? (3) What
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| | occasionally becomes a permanent
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| are health risks?Does Bariatric Surgery
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| | condition.Bariatric Surgery is No Easy
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| Lead To A Significant Loss of Weight?Yes.
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| | Answer To ObesityEven though surgical
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| According to most patient-surveys the
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| | methods are becoming more and more
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| health and weight reduction benefits of
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| | successful for the reduction of severe
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| bariatric surgery exceed all other
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| | obesity, it would be misleading to
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| treatment methods by a wide margin.
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| | present surgery as an easy option. To
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| Weight loss surgery is considered
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| | begin with, its success depends entirely
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| successful when excess weight is reduced
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| | on patient compliance with post-operative
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| by 50 percent and the weight loss is
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| | guidelines. And pressures to overeat do
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| sustained for five years. At present,
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| | not disappear after surgery. If patients
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| average excess weight reduction at five
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| | adhere to instructions, they tend to lose
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| years is 45-75 percent after gastric
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| | weight without regain. If they "cheat",
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| bypass and 40-60 percent after vertical
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| | they tend to regain most of their weight
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| banded gastroplasty. In a statistical
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| | loss and may end up in a worse condition
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| review of over 600 bariatric patients
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| | than before. Second, due to cost and
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| following gastric bypass, with 96 percent
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| | availability issues, bariatric surgery
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| follow-up, mean excess weight loss still
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| | can only ever treat a tiny percentage of
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| exceeded 50 percent of initial excess
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| | the population who are severely obese.
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| weight at fourteen years. Another 10 year
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| | Third, we lack long term feedback on the
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| follow-up study from the University of
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| | success of these operations. For these
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| Virginia reports weight reduction of 60
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| | reasons, it seems that bariatric surgery
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| percent of excess weight at 5 years and
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| | is no easy solution to our obesity
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| in the mid 50's between years 6 and 10. A
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| | epidemic.David Johnson, LLb., is the
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| significant percentage of less-committed
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| | senior researcher at which offers a
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| patients do regain weight 2-5 years after
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| | range of information about gastric
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| having surgery, especially those who
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| | banding, stomach bypass and other
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| undergo the less drastic stomach banding
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| | weight-related surgeries to more than 2
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| procedure, but if the patient is well
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| | million unique visitors per year.
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| motivated and given proper post-operative
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