Should I have a malabsorptive procedure?
Historically bariatric surgeons have thought bariatric surgery primarily works by limiting calorie intake or preventing the absorption of ingested calories. As a result, surgeries are typically characterized as restrictive, limiting calorie intake. Malabsorptive, meaning the gastrointestinal tract, has been altered in some way to prevent absorption of all of the calories eaten. Today we know the procedures result in changes in gastrointestinal tract hormones that affect how our brain sets our weight. However, the more malabsorptive the procedure, the greater the magnitude of the hormonal effect resulting in greater weight loss and obesity-related co-morbidity reduction.
Bariatric Procedures with Significant Malabsorption
| Least Malabsorptive | |
| One Anastomosis Gastric Bypass | |
| Single Anastomosis Duodenal Ileal Bypass With Sleeve | |
| Most Malabsorptive | Duodenal Switch |
Patients get enamored by the increased weight loss of the malabsoptive procedures. They often overestimate their ability to adhere to the very strict, rigorous lifetime requirements to take many daily vitamins and a high protein low fat dietary regimen. This can culminate in being worse off and requiring re-operation to reverse the malabsorption.
Recommended Self Assessment
If you or your family, who know you well, answer “NO” to any of these questions, you should probably not have a significantly malabsorptive procedure. If you do, it may make life worse rather than better for you. Patients can misrepresent this information to your bariatric team, but you will only be hurting yourself.
- My historic “No Show” rate for doctor visits has been less than 5% in the last 5 – 10 years.
- My general philosophy is that of a “rule follower” regarding my health care.
- I take my medications as prescribed.
- I follow up with my doctor when asked.
- I can comfortably afford $200 dollars per month in vitamins and health-related necessities.
- I have minimal concerns about my long-term financial security.
- I have a very stable living environment.
- I plan to live in a region of the country or world with good health care.
- My mental health has been stable for the last five years with no medication or on a regimen that was not difficult to get fine-tuned.
- Drug or Alcohol abuse has not been an issue for me in the last ten years.
- Diarrhea is not a problem.
- I can give up fatty foods.