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主人和客人表达的所有想法和观点都是他们自己的，并不一定反映他们所属机构的观点.
Dr. 米勒: Weight loss surgery, is that right for you? We're going to talk about that next on Scope Radio.
Hi, I'm here today with Dr. 埃里克 Volckmann. 他是一名减肥外科医生，犹他大学的外科教授. 埃里克, 大发娱乐在上节课中谈到了体重指数以及体重增加与超重或肥胖的关系. 你能谈谈什么时候应该考虑减肥手术在什么情况下?
Understanding the Criteria for 减肥手术
Dr. Volckmann: 好吧, most insurers, including Medicare or Medicaid, start approving 减肥手术 身体质量指数为每平方米35公斤，患有与体重有关的疾病, 比如糖尿病, high blood pressure, 高胆固醇, 骨关节炎, obstructive sleep apnea, 诸如此类.
Dr. 米勒: 你能举例说明身高5英尺10英寸的人会是什么样子吗?
Dr. Volckmann: 有人5英尺10英寸, I wouldn't be able to tell you the exact weight, 但我可以告诉你的是，大发娱乐大多数人已经对肥胖和超重这个事实免疫了，你不会认为体重指数为35的人有资格做手术. They don't look like someone we typically consider morbidly obese.
然后, if you have a body mass index of 40 or higher, 你不需要有体重相关的健康问题才有资格做手术. 这些标准来自我1991年NIH关于胃肠手术治疗肥胖的共识会议声明. 当时, 他们的想法是，一旦你的身体质量指数达到35，并且有健康问题，或者达到40或更高, the risk of being at that weight outweighed the risks of surgery, 也就是现在, almost 25 years later, much safer and easier to perform. 他们还认为，不做手术就能长期减肥的可能性相对较低.
Dr. 米勒: 不做手术减肥的几率相对较低，这是真的吗? 例如, 接受减肥计划的患者中有多少人在5年后仍然有效, 仅仅注意运动和饮食就能减掉适量的体重吗?
Dr. Volckmann: 非常低的. What we see with our patients who come to the clinic, 他们中的大多数人至少尝试过5到10次减肥. And it's not the fact that patients can't lose weight. 有时是20、30、40、50磅，但最后体重又会反弹，甚至更多. So you'll see this oscillating, 重量上下波动，整体呈上升轨迹. 大发娱乐要做的就是阻止这种情况，让病人减肥并保持体重. Bariatric surgery is really the most durable, best, and long-lasting form of weight loss that we have in the current day and age.
Long-Term Effectiveness of Surgical Intervention
Dr. 米勒: 我想问的一个问题是减肥手术后的长期情况, what sorts of outcomes do people expect? I mean, do they keep the weight off at five years? What are we looking at there?
Dr. Volckmann: 是的, I compare it to having a bad meal in a restaurant. 每个人都注意到那些做了减肥手术又恢复了体重的人, 就像一个人在餐馆吃了一顿糟糕的饭，他就会大声疾呼. 但是那些减肥手术做得很好的人通常不会告诉别人. 大多数病人减掉了大部分体重，并保持了下去.
So what is the majority of the weight? 大发娱乐谈论的是多余的体重减轻，这是你减掉的体重超过理想体重的百分比. So everything above your ideal body weight is your excess body weight. 胃旁路手术的病人，平均能减掉60%到80%的体重. 所以对于超重100磅的人来说，这意味着他们会减掉60到80磅. Two hundred pounds overweight, 120 to 160 pounds.
胃旁路手术vs. Sleeve Gastrectomy
与 sleeve gastrectomy，平均多余体重减轻约为多余体重减轻50%至70%. So a little bit less than what we see with gastric bypass.
Gastric bypass has been around since 1967. So we know a lot about weight loss surgery. The sleeve gastrectomy has not been around for as long, although it seems to be close to gastric bypass, 但是大发娱乐不知道它对胃旁路很好它似乎和垂直袖胃切除术有点相似.
Lifestyle Changes and Post-Surgery Success
Dr. 米勒: 好吧, if you look at gastric bypass five years out, 你会说大多数做过那个手术的人都能减掉40%到60%的体重吗?
Dr. Volckmann: In my practice here, and we're about four to five years in, it seems like about 90% of our patients have kept the weight off.
Dr. 米勒: 那太好了. That's really great.
Dr. Volckmann: It is a forced lifestyle change and that's what I tell patients, 手术可以大发娱乐他们少吃，在两餐之间保持饱腹感. 然而，更成功的人是那些合理饮食和锻炼的人. It requires really a lifestyle modification. Any of the operations can be overcome by emotional eating, eating for reasons other than hunger, 压力, 焦虑, 抑郁症, 无聊, 和不活动. So when I see patients who have regained the weight, they often have started consuming sugary beverages or . . .
Dr. 米勒: Small meals frequently
Dr. Volckmann: 是的. 他们会开始整天只吃东西，经常做出糟糕的食物选择.
Dr. 米勒: 好吧, this leads me to the discussion that when people come to see you, you have a whole program designed for them, 在他们接受手术之前，他们的饮食习惯就会受到影响, improving their healthy eating. Can you talk a little bit about that?
Long-Term Health Maintenance
Dr. Volckmann: Here at the University of Utah, we're really committed to not only having great short-term outcomes, but we want patients to do well in the long term. And that means staying healthy and keeping the weight off. 保持健康的一部分意味着术后定期服用维生素和矿物质. 所有这些手术都需要你每天服用一次或两次复合维生素，每天服用三次钙和维生素D. 所以，尽管病人的健康状况普遍有所改善，而且不用吃药了, 他们仍然需要服用维生素和矿物质补充剂，并且需要终身跟踪. So this is a commitment. It's certainly not an easy way out. Talk to any patient. 他们会告诉你这并不容易，但他们很高兴自己做到了，而且还会再做一次.
updated: 2024年5月21日
originally published: November 3, 2015
