or gastric bypass surgery, commonly called stomach stapling, may be recommended for people who are morbidly obese. It involves reducing the size of the stomach so that less food is consumed.

Obesity is a condition that affects over 30% of adults in the United States and is associated with comorbidities such as type 2 diabetes mellitus, heart disease, and cancer.  For individuals with clinically severe obesity, defined as having a body mass index above 40 kg/m2, lifestyle interventions may produce insufficient weight reduction.  Weight loss surgery, such as Roux-en-Y gastric bypass (RYGB), has proved to be the most effective clinical intervention for facilitating massive and immediate weight loss in clinically obese patients.In RYGB, the stomach is first divided into a small gastric pouch and a distal gastric remnant, which remains attached to the duodenum.  Next, the jejunum is transected and its lower section is connected to the newly created gastric pouch to form the alimentary limb.  This connection is typically created with surgical staples.  The formation of the alimentary limb allows ingested food to bypass the region composed of the distal gastric remnant, the duodenum, and the upper jejunum; collectively termed the biliopancreatic limb.  Finally, the lumen of the upper jejunum is reconnected to the lumen of the lower jejunum to allow enzymes and compounds to flow freely from the biliopancreatic limb into the alimentary limb.Figure 1  RYGB surgically divides the digestive tract into the alimentary limb and the biliopancreatic limb, which then merge into the common limb.RYGB facilitates weight loss by reducing the functional volume of the stomach and altering intestinal anatomy to induce nutrient malabsorption.  Although the gastric pouch has the same overall function as a normal stomach, the procedure is associated with several complications, such as steatorrhea (fatty stools) due to disruption of lipid digestion, and a more alkaline environment in the gastric pouch.  Animal studies also suggest that RYGB promotes the growth of weight loss–inducing gut bacteria.  Researchers have found that transplanting gut microbiota of obese postoperative RYGB mice into non-operated obese mice lacking gut flora may reproduce the therapeutic effects of RYGB in transplant-recipient mice.Adapted from Bächler T, Le roux CW, Bueter M. How do patients' clinical phenotype and the physiological mechanisms of the operations impact the choice of bariatric procedure?. Clin Exp Gastroenterol. 2016;9:181-9. Question 7All the following are secreted by cells in the alimentary limb of RYGB patients EXCEPT:A.pepsinogen.B.trypsinogen.C.intrinsic factor.D.mucus.

Bariatric surgery has become the most effective treatment for obesit

Darlene is a 5′ 2′′, 23-year-old woman who weighs almost 250 pounds. To lose weight, she's tried calorie-restricted diets, fad diets, exercise programs, and appetite-suppressing pills without success. She would like to try a surgical weight-loss method that reduces the size of her stomach without the use of staples and is reversible. Her physician is likely to recommend ________..Multiple Choicelaparoscopic gastric bandinggastric resectiongastric bypass proceduresleeve gastrectomy

If you had a gastrectomy (removal of the stomach), your ability to absorb macronutrients would be severely impaired.

Select all that applyThe surgical procedure gastroplasty may be recommended for individuals that meet the following criteria. (Select 3.)Multiple select question.have a BMI > 40have been obese for at least 5 yearshave no major psychiatric disordershave a history of yo-yo dieting