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Gastric bypass surgery can affect metabolism

Dear Dr. Roach: I was told that a gastric bypass only makes the stomach smaller and does not affect metabolism. Is this true? — D.R.

Answer: There are several different types of bariatric surgery (surgical procedures designed to help people lose weight). About 50 percent of bariatric procedures done now are of a type called Roux-en-Y gastric bypass. This procedure does indeed make the stomach smaller: The primary means for weight loss is a sensation of the stomach feeling full after ingesting less food. However, the small intestine also is bypassed, causing some food not to be properly absorbed.

Also, removing a portion of the stomach changes some of the hormones involved in weight loss (especially one called ghrelin, which promotes hunger and is made in the portion of the stomach that is removed). So it does affect metabolism. Lower levels of ghrelin lead to less hunger. After two years, the expected loss of excess weight (the difference between what the person weighed and what he or she should weigh) is about 70 percent with a Roux-en-Y. Part of the reason this type of bariatric surgery may be more effective than other types, such as the gastric sleeve procedure or gastric banding, could be due to the hormonal changes associated with removing the ghrelin-producing cells.

Bariatric surgery remains the most effective long-term weight solution for people with serious weight problems, but it is not for everybody.

Readers: The booklet on edema and lymphedema provides information on the causes of foot and ankle swelling. Readers can order a copy by writing:

Dr. Roach

Book No. 106

628 Virginia Drive

Orlando, FL 32803

Enclose a check or money order (no cash) for $4.75 U.S./$6 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible.

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