Medical Procedures for Obesity

Medical intervention in the hospital is sometimes employed in extreme cases of obesity. Hospital procedures include: prolonged fasting, jejunoileal bypass, and lipectomy. These techniques, although often effective, are sometimes accompanied by undesirable side effects.

Prolonged starvation has resulted in weight losses of over 100 pounds. However, this procedure causes loss of lean body mass and can have serious side effects, such as gout, anemia, hypotension, and various metabolic disturbances. Also, starvation does little to modify eating habits, which will help maintain lost weight.

Invasive Treatments
Invasive procedures for treating obesity include gastric bubble, jaw wiring, gastric bypass, gastroplasty, jejunoileal bypass, and liposuction. The long - term effectiveness of temporary measures, such as gastric bubble and jaw wiring, is low — as with starvation, the resting metabolic rate is depressed and healthy eating habits are seldom substituted, so weight is usually regained.

Bypass Operations
Bypass operations, such as gastric and jejunoileal bypasses, are much more effective than starvation and jaw wiring. These
procedures are very expensive, however, and much riskier than less invasive methods. Gastric operations reduce the gastric pouch size, which limits food intake. Clinical reports suggest that these procedures cause substantial weight loss. Although failure rates are as high as 50% , the procedures are satisfying to a large proportion of patients. Surgical risk is present but low. Other risks include vomiting, diarrhea, and peptic ulceration.

Jejunoileal bypass operations decrease the absorption of nutrients. These procedures cause weight losses similar to those from gastric operations. Side effects are much more severe, however, so the procedure is much less popular than it once was. Side effects include surgical complications, diarrhea, electrolyte disturbances, bacterial infection, and liver failure.

Suction Lipectomy
Liposuction has become the most popular type of elective surgery in the United States. The procedure involves removing limited amounts of fat from specific areas. Typically, no more than 2.5 kg of adipose is removed at a time. The procedure is usually successful if excess fat is limited and skin elasticity is good. The procedure is most effective, however, if integrated into a program of dietary restriction and exercise. Side effects include infection, dimpling, and wavy skin contours.

Drugs used in weight control include those that suppress appetite and drugs affecting the gastrointestinal tract.
Appetite suppressants include amphetamine, diethylpropion, fenfluramine, and phenylpropanolamine. Although these drugs depress appetite and cause weight loss, some have serious side effects. Amphetamine, for example , is highly addictive and can cause cardiac arrhythmias and impair temperature regulation.

Drugs affecting the gastrointestinal tract include dietary fiber and sucrose polyester. Dietary fiber causes gastrointestinal distension and may restrict energy intake. Limited clinical trials suggest that including fiber supplements in the diet may aid weight loss. Sucrose polyester (Olestra) is a new diet ingredient of some promise. This substance cannot be digested and can be substituted for fats in the diet.
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