Vol. 20, No. 2 (July 2011)
Bariatric Surgery and Mineral Nutrition
The market surrounding weight loss is one of the largest in the USA and other industrialized nations. Many millions of people turn to diet, exercise, nutritional supplements, and pharmaceuticals to help in their fight against obesity. According to the US Center for Disease Control, morbid obesity (basically people who are at least 100 pounds over their ideal body weight) is the cause for over 500,000 deaths per year in the USA. The incidence of morbid obesity is growing, and is a major health concern. For people who are morbidly obese, and have tried diet and exercise, and the other possible weight loss programs, bariatric surgery may be their best or only hope to sustain weight loss and resolve health conditions. In the early 1990’s, about 16,000 bariatric surgeries were performed in a year. By 2003 this number increased to 120,000 surgeries, and swelled to over 220,000 procedures in 2008, with no end to growth in sight. Long term studies have shown that these bariatric surgeries can cause significant long term weight loss, recovery from diabetes, improvement in cardiovascular risk factors, and a reduction in mortality by a rate of 43%.
Bariatric surgery, or weight loss surgery, includes a select variety of procedures. Bariatric surgery alters the digestive process. There are basically two types of bariatric surgery in practice today: restrictive and combined. The restrictive are those that limit food intake by narrowing the passage from the upper of the stomach to the lower part, known as lap band surgery, lap banding, or gastric banding. The combined methods are those that use stomach restriction and partial bypass of the small intestine. These can be the open Roux-en-Y gastric bypass, the duodenal switch, and the laparoscopic Roux-en-Y gastric bypass. The restrictive methods physically limit the quantity of food intake, but do not interfere with digestion. The combined operations (the most common used forms)physically restrict the amount of food intake, as well as the amount of nutrition that can be absorbed. The U.S. National Institute of Health recommend bariatric surgery for obese people with a body mass index (BMI) of at least 40, and for people with a BMI of 35 with serious coexisting medical conditions, such as diabetes. It is now thought that the minimum BMI for bariatric surgery needs to be lowered to 35 for obesity, and 30 for obesity with other co-morbidities, like diabetes.
The figures to the right represent a combination (figure 1) and a restrictive (figure 2) method for bariatric surgery.