When do we consider surgery?
Patients considered for weight loss surgery must be at least 100 pounds overweight and have a BMI of at least 37 or a BMI of 33 with associated comorbidities such as hypertension, diabetes, or sleep apnea etc. Weight loss surgery is definitely not for those who want a quick fix or who simply don't want to diet. So a history of documented dietery weightloss attempts is asked to identify patients with lifelong commitment to follow-up care and extensive dietary, exercise and medical guidance.

Surgical: We recommend considering surgical weight loss options for these patients. In fact, the risk of death from not having surgery is greater than the risks of surgery ( see Obesity related conditions)

	Restrictive procedures make the stomach smaller to limit the amount of food intake giving early satiety and fullness
	Restrictive and Malabsorptive techniques reduce the amount of food intake and also limit the length of intestine that comes in contact with food so that the body absorbs fewer calories

Gastric Banding

The Adjustable Gastric Band is a hollow band made of sylastic which is placed around the upper third portion of your stomach to create a small stomach pouch that initially holds 2 ounces of food, and eventually holds up to 4 to 6 ounces. Creating this restricted stomach space in the upper portion ofthe stomach causes a longer lasting feeling of fullness because the nerves that signal the brain when you're full are located in the upper area of the stomach. The band further works by slowly allowing the food you eat to be released into the lower portion of the stomach for digestion. Patients are allowed to return home the same day or sometimes require to stay overnight with release from the hospital about 24 hours post surgery. This can be done in the outpatient department during followup visits.

Adjustment:
Immediately after surgery the band is empty. About six weeks after surgery, or whenever a plateau in weight loss is reached, the surgeon may add a small amount of saline in the band. While the band can hold about 4 to 5 cc's of saline, only small amounts of saline are added each time.

This can be done in the outpatient department during follow up visits.

	it can be adjusted to increase or decrease restriction.
	Surgery can be reversed.
	Digestion and absorption is normal.

Gastric bypass operations

	Create a small stomach pouch to restrict the amount of food you can eat.
	Construct a bypass of the duodenum and other parts of the small intestine to cause malabsorption.

Roux-en- Y gastric bypass

Roux-en- Y Gastric Bypass (RGB). This is the most common bariatric procedure. First, small stomach pouch is created with staples. This restricts food intake. Then a Y shaped section of the small intestine is attached to the pouch to allow food to bypass the first and second segments of the small intestine.Thereby changing various hormones secreted by this part.

Thus it helps to cure Type 2 Diabets. This reduces your body's ability to absorb nutrients and calories.

Duodenal Switch(BPD - DS)

(Duodenal Switch, Biliopancreatic Division (BPD). BPD procedure 3/4 of stomach is removed which restricts food intake and reduces acid output. The small intestine is divided and attached to the stomach pouch so that the food you eat moves through the intestine with little absorbtion. In duodenal switch stomach is sleeved retaining the natural stomach outlet. the majority of the small intestine is bypassed so very little food is absorbed.This is generally performed in super obese patient.

Role of Liposuction: Liposuction / lipoplasty / suction lipectomy - is commonly mistaken as an anti-obesity procedure.

It is best for removal of abnormal fat deposits in non-surgical candidates for cosmetic body contouring. So the best candidates are normal weight people with firm, elastic skin who have pockets of excess fat in certian areas that do not respond to traditional wt-loss methods.

It is not recommended as a treatment of morbid obesity. It can be an adjunct to surgical procedures after adequate wt-loss has been achieved to remove certian resistant areas of fat deposits.