DEAR MAYO CLINIC: I have been overweight most of my life. I've tried for years to shed the extra pounds, but nothing works. I'm now 45 and about 100 pounds beyond my ideal weight. I have high blood pressure, and my doctor says I'm at risk for diabetes. I'm considering gastric bypass. Could this surgery work for someone like me?
ANSWER: It can be hard to predict who will have success losing weight and keeping it off after gastric bypass surgery. But physicians do have criteria to help identify good candidates for the procedure. If you have gastric bypass, there are steps you can take after surgery that increase your chances of keeping your weight down, maintaining the weight you have lost and ensuring good health in the long run.
Generally gastric bypass is an option for people who have a body mass index, or BMI, of 40 or higher. BMI is calculated by dividing your weight in kilograms by your height in meters squared. To find your BMI quickly, you can go to Mayo Clinic's website at http://www.mayoclinic.org, and put your height and weight into the site's online BMI calculator.
For people whose BMI is a little lower than 40 but who have other serious health conditions that may benefit from weight loss, gastric bypass also may be a reasonable choice. Those weight-related health conditions include heart disease, uncontrolled high blood pressure, severe arthritis, diabetes, gastroesophageal reflux, high cholesterol and sleep apnea, among others.
Although age used to be a factor in considering candidates for gastric bypass, age is no longer a major consideration. The most common age range for people who have gastric bypass is 30 to 50 years old. At those ages, significant weight loss has been clearly shown to increase life expectancy. Of course, people older than 50 and younger than 30 can see important health benefits and improvement in quality of life from weight loss, too.
There are several health concerns that could disqualify you from getting gastric bypass. The main ones are untreated chemical dependency, untreated major depression or another severe psychiatric disorder.
As part of the preparation process for gastric bypass surgery, many health care organizations require people to complete an education program. These programs provide information about healthy eating and healthy lifestyle choices and cover the long-term changes necessary after gastric bypass. Most also involve meeting with a dietitian or nutritionist on a regular basis.
Some programs may have you meet with a psychologist, psychiatrist or other mental health professional before gastric bypass surgery, too. He or she may assess your emotional and mental health, and help you prepare for the changes you will experience emotionally, physically, and psychologically.
As you consider whether or not gastric bypass surgery is right for you, it's important to keep in mind that gastric bypass is not a stand-alone treatment for obesity. Of the people who are deemed to be good candidates for the procedure and who have gastric bypass, about 60 to 65 percent maintain a weight loss of at least half their excess weight seven years after surgery.
That long-term success depends in large part on a commitment to making permanent dietary changes, getting regular exercise, attending regular follow-up visits with your health care provider and making other healthy lifestyle choices. -- Michael Sarr, M.D., Surgery, Mayo Clinic, Rochester, Minn.
(Medical Edge from Mayo Clinic is an educational resource and doesn't replace regular medical care. E-mail a question to email@example.com. For more information, visit http://www.mayoclinic.org.)
Criteria can help determine if patient is good candidate for gastric bypass
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