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Q: I'm having a hard time finding information on people getting their stomachs stapled. My sister-in-law is 200 pounds overweight and wants to get it done.

Personally, I don't think she needs that kind of pain to endure. I was hoping that, if I could get information, maybe she would think twice.

-- H.T., Gainesville, Ga.
A: I'm sure she has thought more than twice already. And I would hope she would not agree to major surgery of any kind before getting a clear picture of the benefits, risks and costs.

Of course, she won't want to endure the pain of recovery from surgery, but a woman who is 200 pounds overweight may be enduring a lot of physical and emotional pain already.

Your sister-in-law is suffering from morbid obesity, defined as weighing at least 100 pounds over the ideal body weight. And morbid obesity has been shown to be a major health hazard, causing high blood pressure, diabetes, joint disease, gallbladder disease, blood clots and hormonal imbalances.

In addition, the ability to get around and fully participate in daily activities can be severely curtailed. And, to add insult to injury, the person often feels diminished self-esteem and chastisement from others.

Although loving, kind and supportive encouragement from others will help someone with morbid obesity lose weight, all too often he or she is surrounded by a society that is harshly critical and fixated on being thin.

Before surgery, a person should make as much effort as possible to lose weight through other means. This, of course, should include exercise and dieting. Medication, both prescription and non-prescription, and preferably under the guidance of a health professional, should be tried before surgery.

Psychological interventions may also be helpful. Emotional problems could have been the cause of gaining weight initially. But even if not, being 200 pounds overweight may have created psychological problems that need to be addressed now.

If all her other efforts fail and she is experiencing medical or significant psychological problems caused by her obesity, surgical therapy is a reasonable option to consider. Three surgical approaches can be taken: intestinal bypass, gastric bypass and gastric restriction (stapling).

Intestinal bypass was at one time the most commonly performed procedure. Because of long-term complications (some studies showed a 10 percent death rate), it's rarely done today.

Gastric bypass connects the top of the stomach to the intestine, bypassing the bottom of the stomach and the beginning of the intestine. It is safer, but most will develop explosive diarrhea, flushing, dizziness and fainting from time to time.

The goal of gastric restriction is to make the size of the stomach smaller and to prevent it from expanding when eating. This causes a person to feel full much sooner and does not cause any change in the way food is digested.

Gastric restriction is much safer than gastric bypass, with a death rate of less than 1 percent. And the negative side effects are much less. To be effective, though, it requires a greater degree of dietary willpower.

Dr. Allen Douma welcomes questions from readers. Although he cannot respond to each one individually, he will answer those of general interest in his column. Write to Dr. Douma in care of Tribune Media Services, 435 N. Michigan Ave., Suite 1400, Chicago, Ill. 60611. His e-mail address is

This column is for informational and educational purposes only. It is not intended to provide medical advice or take the place of consultation with a doctor or other health-care provider.

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