Answer to Question 1
b
Answer to Question 2
The prevalence of clinically severe obesity is increasing at an incredibly rapid rate. At this level of obesity, lifestyle changes and modest weight losses can improve disease risks a little, but the most effective treatment is surgery. Two procedures, gastric bypass and gastric banding, have gained wide acceptance. Both procedures limit food intake by effectively reducing the capacity of the stomach. In addition, gastric bypass suppresses hunger by changing production of gastrointestinal hormones. The results are significant: depending on the type of surgery, nearly 50 percent of the excess weight remains lost after 15 years. More long-term studies are needed, but surgery with weight loss often brings immediate and lasting improvements in blood lipids, diabetes, sleep apnea, heart disease, and hypertension.
Because the long-term safety and effectiveness of gastric surgery depend, in large part, on compliance with dietary instructions, nutrition care plays an important role in follow-up treatment. Common immediate postsurgical complications include infections, nausea, vomiting, and dehydration; in the long term, vitamin and mineral deficiencies and psychological problems are common. Lifelong medical supervision is necessary for those who choose the surgical route, but in suitable candidates, the health benefits of weight loss may prove worth the risks.
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