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Are Your Eligible for Gastric Bypass-

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					The aim of gastric bypass surgery is to make the patient lose weight and avoid the
morbidities associated with obesity. Patients who are morbidly or severely obese are
at increased risk for health problems, tend to have a shortened life span and are at an
added potential risk from continued weight increase. The risk of severe obesity,
however, has to be weighed against that of the surgical treatment, and the benefits
derived from it. The logical question that comes to mind is: Are you eligible for a
gastric bypass, just because you are overweight?

Meta-analysis of reported studies indicates that patients lose, on average, about 70%
of their excess weight in the first year after gastric bypass, and up to about 80% of
their excess weight by the end of the second year. In general, more than half of the
surgery patients find an improvement of their high blood pressure, nearly 80% of
non-insulin dependent diabetes is controlled without medication after surgery. Obesity
related respiratory problems, including sleep apnea and shortness of breath with
minimal exercise, are known to improve or completely resolve. Arthritis, urinary
incontinence, acid reflux, menstrual irregularity, and certain types of headaches are
also benefitted with weight loss after surgery.

The surgery, however, can cause a variety of complications, including electrolyte
abnormalities, nutrient deficiencies, infections, kidney stones, osteoporosis and even
death.

The criteria for patient selection for the procedure thus, are very stringent and exact. A
risk benefit analysis by a multidisciplinary team, on a case to case basis is imperative
for optimal results. This team consists of physicians, therapists, counselors and
dieticians, apart from the surgeons, to manage associated co-morbidities, nutrition,
physical activity, behavior and psychological needs of the patient.

The National Institutes of Health sponsored a consensus panel whose
recommendations have set the current standard for consideration of surgical treatment.
They recommend that gastric bypass should be advised in people who have a BMI of
40 or higher, or, with a BMI of 35 or higher with one or more related co-morbid
conditions.

The body mass index (BMI) is defined as the body weight (in kilograms), divided by
the square of the height (in meters). A BMI below 18.5 is considered underweight,
while a BMI between 18.5 and 24.9 is in the healthy category. A BMI between 25 and
29.9 is overweight, while 30 to 39.9 is considered obese. Any BMI over 40 is
morbidly obese.

To calculate your own BMI, multiply your weight in pounds by 703.Divide that
answer by your height in inches and divide this answer by your height in inches again.

American Society for Bariatric Surgery (ASBS) has revised these criteria and made
them more comprehensive. They have recommended that you are eligible for gastric
bypass if:

- You weigh twice your ideal body weight or are overweight by 100 lbs or more

- You have a BMI (body mass index) more than 40

- You have a BMI more than 35 with co-morbidities (illnesses related to being
overweight).

- You have been overweight for 5 years or more and have failed to lose weight or
sustain weight loss under supervision

- You are willing to comply with lifestyle and diet changes that require you to eat
multiple small meals. This implies that your dietary intake will be under close
supervision by a qualified nutritionist in consultation with the surgeon, together with
regular monitoring of the blood levels of essential nutrients and nutritional
supplements.

- You realize that surgery is not a solution but it only helps train you to eat much less.
To achieve long-term weight-loss and avoid complications from the procedure, you
must exercise, eat properly and obtain appropriate follow-up care.

- You have a clear understanding of the principles of the surgical options available,
long- and short-term risks, complications, and the need for follow up visits.

- In case you are planning to get pregnant, you must realize that you will need to delay
it by at least eighteen months until after surgery, so that your body has time to recover
from the surgical stress. You must also remember that the weight loss usually results
in a rebound boost in fertility, so you must use birth control measures.

Surgery is not recommended for those with diagnosed alcoholism, overt psychosis,
and major cardiopulmonary disease, which can increase the risks of surgery.

You as a patient have to understand that gastric bypass is not a panacea. Results vary
from person to person, and very often the results are evident gradually. Also, in the
absence of proper postoperative care and lifestyle modifications, the health hazards
are many.

It is therefore essential that you take a decision regarding gastric bypass in
consultation with a multidisciplinary bariatric team, only once you and your treating
surgeon are absolutely convinced of the need for surgery.

				
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