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Weight-reduction surgery (bariatric surgery) causes dramatic weight loss. There are risks to the surgery, and you can have problems after the surgery. It is healthier and safer to lose weight by diet and exercise than by weight-reduction surgery. Most people should make a serious attempt at weight loss by diet and exercise for 6 months before considering weight-reduction surgery. With the diet described in this book you can succeed and avoid a potentially dangerous surgery that has long-term problems associated with it. That said, if after 6 months you are still severely obese, you should consider weight-reduction surgery.
Weight-reduction surgery is effective and produces sustained weight loss in most patients. Gastric bypass is the most commonly performed weight-reduction operation in the United States. People with a BMI over 40 lose on average 40 to 70 pounds after gastric bypass.326 It is clear that much of the weight stays off. However, some studies found that over the course of 10 years, half of the weight is gained back, while other studies found that almost none of the weight is gained back.327 The good news is that diseases caused by too much fat, such as diabetes, become less severe after weight loss surgery.
While it is clear that people with a BMI greater than 40 lose more weight after gastric bypass surgery than from medical treatment, the data is less clear-cut for people with a BMI between 35 and 40.328 The data for people with a BMI between 35 and 40 points to surgery being superior to medical therapy but is not conclusive.
The risk of death from the gastric bypass operation is about 1%.329 Over time, untreated severe obesity has a much higher death rate.
After surgery, patients have less depression and improved self-esteem.330 Usually marital satisfaction increases after surgery; however, divorce is not uncommon.331
Weight-reduction surgery is only for:
• people with extreme obesity (BMI greater than 40)
• people with severe obesity (BMI greater than 35) and serious obesity-related illness (for example, diabetes)
 
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