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updated 1/28/2005 11:06:29 AM ET 2005-01-28T16:06:29

From 1993 to 2003, the number of weight-loss surgeries increased 500 percent. That number was predicted to increase even further in 2004. Since almost two-thirds of our population is now overweight or obese, thoughts about surgical procedures to reduce weight frequently cross people’s minds. Yet misconceptions about them are common. People especially overlook all the necessary life changes for a successful operation.

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Liposuction, one type of weight-control surgery, may seem like a simple way to remove excess fat around the waistline, which is most associated with health risks like diabetes and heart disease. Yet in a recent study of obese women, liposuction that removed large amounts of waistline fat did not lower blood sugar and insulin levels or biomarkers of inflammation.

Although removing fat deposits under the skin can significantly change a person’s appearance, the health risks from excess weight appear to come from fat deep in the abdomen around or inside organs, which liposuction leaves in place.

Unrealistic expectations
Furthermore, a new study suggests that people who opt for liposuction often have unrealistic expectations about the extra measures they must take to maintain the new look and lower weight. Although the patients were generally satisfied with the liposuction surgery, 43 percent regained weight. This large percentage seems to have underestimated the importance or ease of making lifestyle changes to prevent weight from returning. Almost all of those who regained weight did not increase their level of exercise or change their diet after surgery.

Other weight-control surgeries for obese people alter a person’s digestive process to cause the body to lose weight over time. One of the surgeries reduces the size of the stomach. Another type, called a gastric bypass operation, forces food to bypass sections of the digestive tract, reducing the amount of calories and nutrients that the body can absorb. Bypass operations tend to produce more weight loss, but they also pose the most side effects, including nutritional deficiencies. Both kinds of surgery, however, are significantly more effective than medications or counseling.

Lifestyle changes
Yet people may underestimate the permanent changes in eating habits they will need to adopt after either kind of surgery. Because of the changes in the digestive tract, people need to learn to chew their food more thoroughly than before. Liquids need to be consumed separately from solid foods.

Although some people adapt to the required lifestyle changes, experts say that many others continue to struggle with emotions related to food after surgery. Counseling to cope with stress and other emotions without turning to food should be a vital part of anyone’s plan to make these operations successful.

People who are considering surgery to treat obesity also need to think about the likely outcome. A 30 percent weight loss is about typical. Nevertheless, since candidates for these extreme procedures are so obese, the typical person remains overweight. Although people may not reach their ideal weight, these large weight losses can produce tremendous health benefits. However, if a person expects to be thin and envisions automatic life changes, like more friends, a better marriage and professional success, they can become depressed.

When people weigh the risks and benefits of surgery for weight reduction, complications should also be considered. Although rare, they can be severe. Severe obesity, however, also has health risks that include heart disease, diabetes, sleep apnea and cancer that can be just as harmful. Perhaps, surgery may be an ideal solution to a severe weight problem, but all the factors need to be weighed before people select this option.

Nutrition Notes is provided by the American Institute for Cancer Research in Washington, D.C.

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