Just two weeks after surgery however, on 4 March 2007, she suffered a massive heart attack and tragically died.

Renee Williams had struggled with her weight from an early age and by the time she was just 13 years of age she had already reached nearly 300 pounds. Two years later, at the age of 15, she married and by 21 she had two children. Her weight continued to rise and in her early twenties hovered around 400 pounds.

It was in 2003 however that her life changed dramatically when she was involved in a car accident when a drunken driver crashed into her SUV and suffered severe injury to her left leg which left her unable to walk and confined her to bed. From that point onwards her weight began to rise steadily and, by the start of 2007, she had passed 800 pounds.

Unable by this time to get out of bed at all, Renee’s only contact with the outside world was through the television and her laptop computer and she became increasingly desperate to lose weight so that she could realize her dream of marrying her new fiance and becoming a mother once again to her children, who had not seen her out of bed for more than a year. With this aim in mind she began searching for a bariatric surgeon who would be willing to perform the necessary weight loss surgery.

Gastric bypass surgery is routinely carried out these days on morbidly obese patients whose body mass index (BMI) typically ranges from about 40 to 60. Indeed, it is expected that some 140,000 operations will be carried out in 2007. Weight loss surgery is not however without it risks for the average patient, but these risks increase considerably as BMI rises and, with a BMI of 137, Renee was turned down by no fewer than twelve surgeons before finally being accepted for surgery by two surgeons from the Renaissance Hospital in Houston.

Her laparoscopic gastric bypass surgery went well despite the fact that it lasted five hours, required two operating tables and some considerable adaptation to existing operating equipment and techniques. Her initial recover also appeared to be going well and, in the two weeks following surgery, she lost no fewer than 67 pounds which was a good start towards her surgeon’s predicted loss of 650 pounds over a three year period after surgery.

Tragically however, without any warning, she began suffering chest pains which were quickly followed by a massive heart attack from which doctors were unable to revive her.

For many people today Renee Williams is seen as an inspiration and this is especially true for those who were able to listen to her speaking in a number of interviews both before and shortly following her surgery. But, for others, her death serves as a warning. The risks of gastric bypass surgery are well known and, in particular, it is well understood that, as BMI increases, so too does the risk of developing cardiovascular problems.

Was Renee Williams brave or foolish to undergo surgery in her condition? Were the surgeons right to perform this operation? These and many other questions will be debated for some time to come. One thing is certain however and that is that the problem of obesity should be tackled as soon as it arises and that those who wait are far more likely to find their hopes and dreams shattered.

Carnie Wilson is the daughter of the Beach Boy musician Brian Wilson, whose own troubled life led to considerable strain between Carnie and himself. Largely because of their strained relationship, Carnie began putting on weight at about the age of four and, by the time she had reached twelve, she was already on the first of what were to become many years of failed diets.

She really began to put on weight though when she began singing professionally with Wilson Phillips and found that the stress of performing led her into late night binge eating. When she started her singing career she weighed around 180 pounds but by the time she had cut her second album her weight had risen to 240 pounds. From there it continued to rise and reached 300 pounds by the summer of 2001.

At this point Carnie’s weight started to affect her health and frequent bouts of choking in her sleep left Carnie terrified that she was going to have a heart attack. At the same time she dreamed of being able to wear a white T-shirt and 501 jeans and eventually decided that if she did not face up to weight loss surgery her growing size was going to kill her.

So, she announced publicly that she intended to undergo Roux-en-Y gastric bypass surgery as she knew that it was the only answer to her weight problem and that it was something that she simply had to do.

Over the coming weeks and months her many fans followed her progress and were delighted to see her lose 150 pounds and realize her dream of being able to wear that white T-shirt and those 501 jeans.

Although Carnie Wilson knows that she will always have to struggle to maintain her new weight, like many thousands of people in a similar position, she was more than happy with the results and with the new lease of life and freedom that the Roux-en-Y gastric bypass surgery had given her.

Digestion starts as soon as you begin eating when, as food is chewed in your mouth, saliva, containing the digestive enzyme amylase, mixes with your food and begins to break down carbohydrates. It may not appear this is an important part digestion, but the saliva glands produce approximately 40% of the amylase used in the digestive process and so it is essential to chew your food well.

Your food is then passed along the esophagus and into the stomach where digestive juices and pepsin are added and muscular contractions mix the food.

Once the food is well mixed it is passed out of the lower end of the stomach through the pylorus, which is a circular muscle that opens and closes rhythmically to control the passage of food from the stomach.

Once it has left the stomach food enters the duodenum, which is about 2 feet long and is the first of three sections which together comprise the small intestine. At this point two other organs come into play – the pancreas and the liver.

The pancreas is mainly known as the organ responsible for producing insulin, but it also produces several digestive enzymes, including lipase, which helps in breaking down fat.

The liver excretes bile, which is a necessary enzyme for the digestion of fat, into the duodenum and also receives nutrients from the duodenum along a series of veins known as the portal veins. The liver is therefore also responsible for processing food.

Having been mixed with several digestive enzymes in the duodenum, food then passes into the jejunum, which is approximately 6 to 8 feet long, and then into the ileum, which is approximately 10 to 12 feet long, where digestion continues and further nutrients are extracted.

As soon as digestion is complete any indigestible waste products are passed into the large bowel where water is absorbed to prevent unnecessary water loss from the body. Waste products remain in the large bowel until they are released from the body.

By bypassing part of the small bowl, gastric bypass surgery prevents the body from absorbing too many calories from the food that is eaten which results in weight loss. It also restricts the absorption of several necessary vitamins and minerals and this is the reason why patients need to take supplements following surgery.

Gastric bypass surgery has been performed for more than fifty years now and, although there are naturally risks as there are with any surgical procedure, in the majority of cases patients are more than happy with the results and enjoy a vastly improved standard of living. But there is a price to pay for this.

Following gastric bypass patients will need to adjust to a very different lifestyle and this can be hard if adequate preparation is not made before surgery to ease patients gently into a post-operative regime.

Of course some changes are obvious. The principle behind gastric bypass surgery is to drastically reduce the size of the stomach and physically restrict the amount of food that the patient can eat with the result that patients obviously understand that the days of sitting down to big meals are over. But other consequences of surgery are less obvious.

The days of eating foods that are high in sugar or fat, even in small quantities, are also over. The results of eating such foods can be very unpleasant as the rapid absorption of these foods in the now shortened digestive tract can lead to extremely unpleasant feelings of faintness.

Patients also find that the dramatic change in their eating pattern leaves them very short of water and they have to adjust to constantly drinking small amounts of water throughout the day if they are to avoid dehydration.

This quite dramatic change in lifestyle is all well and good but what can gastric bypass achieve in terms of weight loss?

There is no simple answer to this question as results will vary from individual to individual. However, as a guide, we need to start by understanding how post-operative weight loss is measured.

The first thing to do is to assess how much excess weight the patient is carrying and this is done by calculating the patient’s ideal weight. Measured in pounds, for a man this will be 106 plus 6 times his height in inches less 60. If that sounds complicated then here’s an example. For a man 5ft 10ins tall his height in inches is 70. Deduct 60 from this and multiply the result of 10 by 6 to give you 60. Finally, add 106 and 60 together and the ideal weight for a man of 5ft 10ins is 166 pounds.

In the case of women the principle is the same but this time a women’s ideal weight is 100 plus 5 times her height in inches less 60.

Using the example of our man above, if prior to surgery he weighs 366 pounds then his excess weight is 200 pounds. Weight loss is then measured in terms of the percentage of excess weight that he loses over time. So, if after 6 months he has lost 100 pounds then his weight loss will be 50%. In other words, at that point he will have lost 50% of his excess weight.

In general patients can expect to lose about 50% of their excess weight within 6 months of surgery rising to 70% one year after surgery and to 80% after 2 years. For the majority of patients weight loss will not continue beyond 2 years and indeed some long-term weight gain will appear after 2 years, typically between 10% and 15% of the patient’s excess weight.

In addition, patients who are excessively overweight will lose a greater percentage of the excess weight (perhaps as much as 90% or 95%) while people who are less overweight may lose at little as 60% within 2 years of surgery.

It is interesting to note that patients very rarely lose 100% of their excess weight and so do not achieve their ideal weight as a result of surgery. For this reason, it is occasionally said that gastric bypass surgery is not completely success. The vast majority of patients would not however agree with this.

While they may not achieve their ideal weight and may have to condition themselves to a very different lifestyle following surgery, for the vast majority of patients the results achieved and the improvement in their quality of life is unimaginable.

However, complications from gastric bypass surgery (in which a new small stomach pouch is created and part of the intestine is bypassed) are significant and need to be considered carefully before embarking on surgery.

Many studies have been done on gastric bypass complications in the short-term, following the progress of patients for up to 30 days after surgery. However, a more recent study (based on claims for both hospital care and outpatient care for some 5.6 million individuals enrolled in employer sponsored health plans across 49 states and including more than 2,500 bariatric patients) has extend previous studies to look in detail at complications arising up to 6 months after surgery.

The first thing that this study did was to confirm the much quoted figure of 40% as the overall gastric bypass complication rate. To most people this figure will seem alarmingly high but, as we have seen in a previous article “Is The Gastric Bypass Risk Figure Of 40% Accurate?”, while this figure may be factually accurate it is arguable whether or not some of the risks included in the findings are truly significant.

The study found that the most commonly seen complications were dumping syndrome (including vomiting, reflux and diarrhea) which occurred in 20% of cases, anastomosis problems (problems such as leakage or stricture arising from the joint between the stomach and the intestine) which occurred in 12% of cases, abdominal hernias occurring in 7% of cases, infections arising in 6% of cases and pneumonia seen in 4% of patients. It was also noted that death occurred during, or in the 6 months following, surgery in only 0.2% of patients.

When comparing the often studied 30 day post-operative period and the 6 month post-operative period it was found that just over 10% or patients who survived the first 30 days without complication went on to experience a problem in the following 5 months.

In most cases these were problems of dumping, abdominal hernia, anastomosis problems and marginal ulcers. It was also noted that, while just under 5% of patients needed to be re-admitted during the 30 day period, this figure rose to just over 7% when considering the longer 6 month timescale.

These problems can perhaps be said to arise as the result of the procedure itself, whether this is roux en y gastric bypass surgery or other weight loss operations such as a gastric sleeve (with or without a duodenal switch) or other modern forms of surgery which are not strictly a form of gastric bypass such as lap band surgery. These complications are thus to a certain extent dependent upon the expertise of your surgeon and members of your surgical team and also dependent upon just where you choose to have your surgery.

In addition however there are also a variety of complications of gastric bypass surgery which will arise out of your post-operative diet and the food which you eat. This is a critical area as it is very easy to suffer such things as vitamin and mineral deficiencies, with many patients suffering from such things as iron and calcium deficiencies. Anemia (a deficiency of red blood cells) is also a problem for many people after surgery. Getting your diet right is extremely important and you will need to seek dietary information from your medical center, as well as their advice on the need for adding supplements into your diet.

The cost of gastric bypass surgery was also significantly affected by complications.

For patients undergoing surgery without complication the average cost was just over $25,000 but complications within the 6 month post-surgical period increased this figure to just over $36,500. However, in cases where patients had to be re-admitted to hospital as a result of gastric bypass complications the cost rose to just over $65,000.

The study carried out at the Yale University School of Medicine involved nearly 140 extremely obese patients and looked at their eating habits prior to surgery and then followed them up during the twelve months after gastric bypass surgery.

Of the study group, some 40 patients reported binge eating in the month before their operation and approximately ten percent of the study group were classified as meeting the criteria to be diagnosed as having binge eating disorder. It was also noted that those people classed as binge eaters were considerably more nervous about their impending surgery than the non-binge eaters.

Following surgery the study noted that there was no difference of note between the two groups and that both binge eaters and non-binge eaters showed virtually identical weight loss profiles in the twelve months after their gastric bypass.

Prior to surgery the average body mass index was 51.7, placing the group well over the body mass index figure of 40 which defines extreme, or morbid, obesity. One year after surgery this figure had fallen to just 33.3, bringing many of those in the study group close to a normal body mass index.

Also of importance, this study reported that, although some of the binge eaters did experience slightly elevated, but relatively easily managed, eating related disturbances after surgery, their pre-surgical anxiety had reduced considerably and there was little if any difference at all between binge eaters and non-binge eaters in terms of depression following surgery.

While the results of the study are of course encouraging, it should be remembered that the study has only followed this group of patients for a period of twelve months so far. It will be necessary to see this, and other studies, running over a period of several years following gastric bypass before we can be sure that these initial results will hold true in the longer term.

Steering clear of sugary foods after surgery can be difficult for many patients as sugar forms such a major part of many diets and it is the sugary foods that are invariably our favorites. Natural sugars are however generally safe and so diets containing such things as fruit and skimmed milk are fine.

The number of deaths from obesity in the United States, which continues to rise annually, had reached a staggering 400,000 by the turn of the century and this places obesity only a short head behind smoking which remains the number one killer in America today.

As obesity continues to grow an increasing number of people are turning to surgery for morbid obesity as the cure for their weight problem.

Surgery is not however an easy option, even with the introduction of simpler surgical techniques such as laparoscopic adjustable gastric banding approved for use in the US by the FDA in June 2001.

It is nevertheless an effective solution and can not only produce dramatic weight loss in a relatively short space of time but can also allow patients to maintain their weight loss â€â€œ something that traditional diet and exercise simple does not achieve.

The problem however is that obesity is seen very much as a problem of weight and surgery is viewed very much as a form of radical but effective diet. Doctors insist that patients try a regime of diet and exercise before embarking on surgery, as do the insurance companies, and it is only when a normal diet program fails that they turn to the more drastic surgical diet. This is all well and good, but it seems to miss the central point at issue.

Being overweight doesn’t kill you!

People do not die because they are overweight. They die because being overweight places a strain on the body and gives rise to a variety of conditions such as type 2 diabetes, hypertension, sleep apnea and liver disease which can result in death.

Now if you are admitted to hospital with coronary heart disease and the doctors recommend heart surgery as your best or only option nobody, including your insurance company, is going to question the surgeon’s recommendation.

But, if you are severely obese and go into hospital with hypertension which your doctor feels will almost certainly lead to coronary artery disease if not treated and recommends surgery to cure your severe obesity, and consequently relieve your hypertension, everybody is going to hold up there hands and say “hang on a minute all we need here is a regime of diet and exercise”.

As a society we tend to view obesity as being something of a “personal problem” which most people could have avoided if they had taken better care of themselves. Weight loss surgery is also all too often viewed as a “cosmetic” procedure designed to make people look and feel better and to allow them to get back to leading the active and enjoyable lifestyle which they enjoyed before they put on so much weight.

It is all too easy to ignore the fact that we as a society have created many of the conditions which all too frequently lead to obesity and that those suffering from severe obesity face the very real possibility of death without the ability to get the help they need.

There are of course numerous theories being put forward for the increase in the rate of obesity in the US and the UK over the past twenty-five years (and the associated rise in the number of people resorting to gastric bypass as the solution to their obesity problem) but, whatever the reason, most observers agree that the following factors all play a part:

Insufficient activity. Both in terms of employment and recreation people are far less active than they once were with far fewer people engaged in manual work and an increasing number of people choosing to pursue relatively sedentary recreational activities. It is also interesting to note that obese people tend to be less active but that this does not stem directly from their obesity. In general weight gain (or loss) does not affect an individual’s level of activity but a change in activity does produce a gain (or loss) in weight.

A reduction in the cost of food. The relative cost of food today is lower in the US and much of Europe than at any time in history and the majority of people in both the US and the UK are able to eat more or less as much food as they want.

The low cost of motoring. Two and even three car families are commonplace today and more and more people are taking to their cars even for the shortest of journeys in preference to using public transport or walking.

Changing work patterns. In addition to the lower activity in many forms of employment as more of us sit behind a desk or at a computer, it is also increasingly common for both partners to work rather than for one partner to look after the home and take care of cooking the meals. This, in turn, results in a rise in the number of people eating out at restaurants or buying take-out meals on the way home.

The rise in the popularity of fast food restaurants. The increasing popularity of fast food restaurants has given rise to intense competition which has, in turn, led to increased portion sizes. A regular order of fries at McDonalds used to be around 200 calories but today is up around 600 calories.

Increased food production. Although perhaps not quite such an obvious cause the fact that US now produces about three times as much food as the country needs also adds to the problem of obesity, principally by further reducing the cost of many staple food items to the food producers.

An aging population. As we age our metabolism slows and we require fewer calories to meet our daily needs. Eating habits however do not generally recognize this fact and so obesity tends to become an increasing problem with age for an individual. However, where a population as whole is aging, as is the case in the US and the UK, obesity also increases across that population.

One interesting and apparent anomaly in the environmental factors aiding the growth of obesity would seem to be the craze for dieting and exercise which has swept across both the US and the UK. In fact this is in itself also adding to the problem as studies have clearly shown that the vast majority of diets do not work and invariably people actually gain weight once they come off a diet.

Dieting however becomes something of an obsession for many people and they diet almost as frequently as they change their underwear, creating a pattern of falling and rising weight which, over time, results in a gradual rise in weight.

The net result of the rise in obesity on both sides of the pond is a corresponding increase in the number of people abandoning the diet and exercise routine and opting for the gastric bypass as the solution to their problem. While this is not an easy option it is certainly an effective one.

Right now obesity is probably the leading health problem in the Western world and in the USA alone about 60 percent of people are overweight, with almost 24 percent being obese and 3 percent severely obese. Now 3 percent may not appear to be high figure but when you consider that it equates to more than 9 million morbidly obese people this is a fairly big problem.

In spite of the fact that attention is increasingly being turned towards the problem of obesity and its cure, it is surprising how much we still have to learn about the condition, including the affects of alcohol on individuals who have undergone gastric bypass surgery.

For some time now there has been a fair amount of anecdotal evidence to suggest that individuals who have had obesity surgery are more susceptible to the affects of alcohol than others but it was not until late last year that any real attempt was made to determine the extent of the problem.

In a reasonably low-key study the affects of alcohol on 19 individuals who had undergone obesity surgery was compared to the affects on 17 control subjects. The people in the study were each given a small 5 ounce glass of red wine and their breath alcohol was then analyzed at 5 minute intervals until it had fallen back to zero.

The study discovered that alcohol levels reached a higher level in the obesity patients and also took much longer to fall back to zero. However, most interestingly, the study also demonstrated that just a single small glass of wine was enough to push the breath alcohol level in several obesity surgery patients over the legal alcohol level for driving in several states.

The explanation for the added affects of alcohol on obesity surgery patients is fairly easy to understand because surgery both reduces the volume of the stomach and bypasses a section of the intestine, both areas of the body which play a significant role in breaking down alcohol before it finds its way into the bloodstream.

So just what does this mean for obesity surgery patients?

Well, apart from the clear need to take care and certainly to refrain from driving after drinking even very small amounts of alcohol, the implications for obesity surgery patients do in fact go a little wider.

One particular problem is that alcohol is a relaxant and this causes problems with post-operative weight loss and to maintaining weight loss. As alcohol relaxes the stomach, including the lower esophageal sphincter, and the intestine, patients who enjoy alcohol can eat more and the presence of alcohol in effect counteracts the affects of surgery. As if this were not bad enough many individuals become more active socially following surgery and this often means an increasing intake of alcohol.

There will still need to be considerably more research carried out but, at the end of the day, the fact is that individuals who have undergone gastric bypass surgery need to be aware of the risks of alcohol and watch their consumption accordingly.

A short, simple and relatively inexpensive form of minimally invasive weight loss surgery typically involving less than 45 minutes in surgery and no more than an overnight stay in hospital, the advertising certainly makes it seem an attractive prospect – at least when compared to the alternatives.

But is mini gastric bypass surgery really such a good choice?

The number of people undergoing weight loss surgery has been rising dramatically from some 20,000 surgeries ten years ago to more than 200,000 operations which will be performed this year in the United States alone.

Against this background it is estimated that less than 4,000 people worldwide will opt for the mini gastric bypass, which is far from a ringing endorsement for this attractive sounding option. So why are so few people choosing this route?

Weight loss surgery began its life back in the 1950s, but much of today’s surgery is based upon the work of Dr Mason and Dr Ito and arises out of observations they made on the weight loss of women undergoing partial gastrectomy for peptic ulcer disease.

One of the early forms of gastric bypass surgery involved the use of a small loop connected to the re-constructed stomach pouch which proved to be a relatively simple procedure and produced some very encouraging results. Unfortunately, however, this procedure also allowed digestive juices from the small bowel to enter the gastric pouch and these extremely corrosive juices sometimes gave rise to severe ulceration of both the stomach and the esophagus.

As a result, the procedure was quickly abandoned and further experimentation led to a number of more successful procedures, some of which are still widely used today, such as the Roux-en-Y gastric bypass.

The dramatic increase in the demand for weight loss surgery in the past few years has given rise to a similar growth in the number of surgeons performing bariatric surgery and in the number of medical centers specializing in weight loss.

Competition between centers is fierce in this not only high demand, but also highly lucrative, field and, amongst other things, this has given rise to a number of variations of long accepted “standard” surgical techniques as centers compete for customers. One such variation is seen in the return of the early “loop” gastric bypass (although now performed laparoscopically) under the highly marketable name of the mini gastric bypass.

Those looking at this particular option must of course judge for themselves whether or not the passage of time has resulted into sufficient improvement in this technique to make it a sound option, but while it may be simple, fast and reasonably free of complications in the short-term (and while mini gastric bypass costs are also attractive) there is considerable medical literature available suggesting that serious long-term complications are likely to arise from the mini gastric bypass.